短尾万向联合长尾单向椎弓根螺钉在峡部裂性腰椎滑脱症中的应用

目的探讨短尾万向及长尾单向椎弓根螺钉复位内固定系统结合椎体间植骨融合治疗峡部裂性腰椎滑脱症的临床效果。方法 2010年6月至2012年1月郑州市骨科医院采用短尾万向及长尾单向椎弓根螺钉复位内固定系统结合椎体间植骨融合治疗74例峡部裂型腰椎滑脱症患者,术后3、6个月行腰椎CT平扫＋二维重建检查,评价滑脱复位、椎间隙高度和植骨融合情况;术后6个月采用Beaujon功能评分（BFS）进行疗效评估。结果手术时间90~135 min（平均112 min）,出血量300~750 mL（平均420 mL）。术中未发生马尾、神经根损伤,1例出现硬脊膜撕裂继发脑脊液漏。所有患者获有效随访,随访时间6~12个月,平均随访时间8.1个月。术后3、6个月滑脱椎体复位率和植骨融合率分别为（93±5）%、（91±4）%和81%、100%;术后6个月BFS较术前明显改善（P〈0.05）,BFS好转率为（79±4）%,优51例、良16例、中6例、差1例,优良率为91%（67/74）。随访期间滑脱复位程度和椎间隙高度无明显丢失。结论短尾万向及长尾单向椎弓根螺钉复位内固定系统结合椎体间植骨融合治疗峡部裂性腰椎滑脱症,植骨融合率高,并发症少,滑脱复位满意。

Application of short-tail multiaxial and long-tail uniaxial pedicle screw spinal system for treatment of lumbar isthmic spondylolisthesis

Objective To discuss the clinical effects of operative treatment of lumbar isthmic spondylolisthesis（LIS） with short-tail multiaxial and long-tail uniaxial pedicle screw system combined with intervertebral bone grafting. Methods Clinical data of 74 LIS patients were collected, who were treated in Zhengzhou Orthopedic Hospital by posterior decompressive laminectomy, short-tail multiaxial and long-tail uniaxial pedicle screw fixation combined with intervertebral bone grafting from June 2010 to January 2012. Lumbar CT scanning ＋ 2D reconstruction were performed at 3, 6 months postoperatively to evaluate intervertebral height, the effects of spondylolisthesis reduction as well as fusion; Beaujon functional score（BFS） was recorded at 6 months after the surgery. Results The operation time was 90-135 min with the average of 112 min, the estimate blood loss was 300-750 ML with the average of 420 mL. Equina, nerve root injury had not happened during the operation, while cerebrospinal fluid leakage occurred in 1 case due to dural laceration. All patients were followed up from 6 to 12 months（average 8.1 months）. At 3, 6 months postoperatively, spondylolisthesis reduction rate and bone graft fusion rate was（93 ± 5）%,（91 ± 4）% and 81%, 100% respectively. BFS improvement rate was（79 ± 4）%. There were excellent in 51 cases, good in 16 cases, fair in 6 cases and poor in 1 case, with the excellent and good rate was 91%（67/74）. No obvious loss of spondylolisthesis reduction improvement and intervertebral height were found during the follow-up. Conclusion For patients with LIS, short-tail multiaxial and long-tail uniaxial pedicle screw spinal system combined with intervertebral bone grafting could provide high fusion rate, less complication and satisfactory spondylolisthesis reduction.