椎管减压、内固定联合Cage椎间融合与横突间植骨融合治疗退行性腰椎滑脱的比较

目的 比较腰椎管减压、椎弓根内固定联合后路Cage椎间融合与横突间植骨融合治疗退变性腰椎滑脱合并腰椎管狭窄的早期临床疗效。方法 分别采用椎管减压、椎弓根内固定联合后路Cage椎间融合与横突间植骨融合治疗经严格保守治疗无效的退行性腰椎滑脱患者31例和19例。比较术后临床症状改善和滑脱复位情况。结果 随访时两组患者腰骶部疼痛改善率分别为80％和84．2％，间歇性跛行改善率分别为88．46％和85．7％。I度滑脱完全复位分别为26例和14例，Ⅱ度滑脱完全复位分别为3例和2例，总复位率分别为93．5％和84．2％。所有病例椎间高度恢复正常或接近正常，Cage位置良好，无脱出，未见下沉。椎弓根内固定器无脱出、弯曲和断裂。结论 椎间融合与横突间植骨融合治疗退行性腰椎滑脱都能达到满意复位，可以充分减压，重建脊柱生理序列和稳定性，在复位率、症状改善率、手术后并发症方面均无显著性差异，临床效果满意。

A comparison of the treatments of degenerative lumbar spondylolisthesis with canal decompression and transpedicle instrumentation combined with cage interbody fusion or intertransverse bone grafting

Objective To compare the early clinical effect of instable degenerative lumbar spondylolisthesis treated by decompressive laminectomy, transpedicle instrumentation combined with cage posterior lumbar interbody fusion (PLIF) or intertransverse bone grafting(IBG). Methods 50 cases of degenerative lumbar spondylolisthesis accompanied with lumbar canal stenosis were divided into two groups randomly of A (PLIF group, 31 cases) and B(IBG group, 19 cases). The strict conservative treatment was ineffective in both of the groups. Group A were treated with PLIF, while Group B with IBG. The clinical outcome and reduction of spondylolisthesis were compared postoperative and preoperatively. Results All the cases were followed up for the average of 14 2 months in Group A and 18 4 months in Group B. The results showed that pain of lumbarsacri relief rate was 80% in Group A and 84 2% in Group B, intermittent claudication improved rate was 88 46% and 85 7% and the anatomical reduction rate was 93 5% and 84 2%.No infection or neurologic complication occurred in this series. No instrument failure was found. Conclusion Both cage PLIF and IBG have satisfactory preliminary clinical result for the treatment of the degenerative lumbar spondylolisthesis. Complete decompression, the recovery of constructive properties and stability of spine can be obtained, and the rates of reduction, improvement of symptom and complication have no significant difference.