后路椎体间融合术治疗腰椎节段性不稳定

目的：探讨后路椎体间融合术(PLIF手术)治疗腰椎节段性不稳定的临床疗效，比较不同种类的椎间融合技术。方法：本组采用3种PLIF手术治疗腰椎节段性不稳定患者72例，共82个节段。其中椎体滑脱28例，间盘突出合并节段性不稳定19例，不稳定型椎管狭窄25例。3种椎间融合技术包括：单纯植骨、双侧椎问支撑器、单侧斜行椎间支撑器，术中均采用椎弓根固定系统辅助，后2种方法中在安放内置物的同时，均辅以椎间自体骨屑植骨。结果：术后随访6个月～5年8个月，平均3年6个月。4～6个月后均达骨性愈合，无固定螺钉松动、断裂及再滑脱现象。患者的腰痛、下肢疼痛症状均有明显缓解，绝大多数病人恢复原正常的工作和生活。VAS疼痛分值术前平均为7.4分，术后下降至3.1分。功能评定结果：优41例，良24例，可7例，差0例，优良率为90．28％。结论：PLIF手术是治疗腰椎不稳症的一种可靠手段，只要把握手术适应证，可以取得满意的结果。

Treatment of lumbar segmental instability with posterior lumbar interbody fusion

Objective:To study the clinical outcomes of posterior lumbar interbody fusion(PLIF) on lumbar segmental instability and to compare the different techniques of interbody fusion.Method:72 cases(82 segments) with lumbar segmental instability were treated by PLIF with 3 kinds of interbody fusion techniques.The diagnostic categories include spondylolisthesis(28),unstable disc herniation(19) and unstable lumbar stenosis(25).In all the cases,pedicle screw systems were used.Three techniques of interbody fusion were adopted,autologous bone graft only,double spacers with autograft,and single oblique spacer with autograft.Result:The follow-up periods range from 6 months to 5 years and 8 months,average 3 years and 6 months.The bony fusions were presented 4~6 months postoperativly.In this series,no fixation failure and recurrent slip were found.After operation,the low back pain and leg pain were relieved significantly in most of the cases.The VAS:preop 7.4 and postop 3.1.Functional outcomes:excellent in 41 cases,good 24,fair 7,poor 0.The excellent and good ratio is 90.28%.Conclusion:PLIF is reasonable options in treating the degenerative lumbar instability.As long as the operation indication is mastered,PLIF usually yields satisfactory clinical outcomes.