腰椎椎间孔外椎体间融合结合椎弓根螺钉内固定治疗退变性腰椎滑脱

目的探讨腰椎椎间孔外椎体间融合结合椎弓根螺钉内固定治疗退变性腰椎滑脱的疗效。方法采用腰椎椎间孔外椎体间融合结合椎弓根螺钉内固定治疗22例退变性腰椎滑脱患者。记录手术时间、术中出血量、住院时间、切口愈合情况、椎体复位情况、手术前后腰痛VAS评分及椎间融合情况,末次随访时采用Nakai标准评定临床疗效。结果手术时间90~150 min,术中出血量40~280 ml,住院时间8~16 d,患者均未输血。21例切口甲级愈合,1例糖尿病患者出现切口延迟愈合。患者均未发生神经损伤、脑脊液漏等并发症。术后摄X线片复查显示滑脱均复位。22例均获得随访,时间9~18个月。术后8~12个月椎间均骨性融合,未见内固定松动、断裂。末次随访时,腰痛VAS评分为1~4(2.5±1.1)分,与术前5~9(6.3±2.7)分比较差异有统计学意义(P<0.05)。末次随访按Nakai标准评定临床疗效:优18例,良3例,可1例,优良率为21/22。结论腰椎椎间孔外椎体间融合结合椎弓根螺钉内固定治疗退变性腰椎滑脱创伤小,疗效满意。

Treatment of degenerative lumbar spondylolisthesis with extraforaminal lumbar interbody fusion combined with pedicle screw internal fixation

Objective To investigate the effect of extraforarminal lumbar interbody fusion combined with pedicle screw internal fixation in the treatment of degenerative lumbar spondylolisthesis.Methods The 22 cases of degenerative lumbar spondylolisthesis were treated by extraforaminal lumbar interbody fusion combined with pedicle screw internal fixation.The operation time,intraoperative bleeding volume,hospital stay time,incision healing condition,vertebral reduction situation,VAS of low back pain before and after operation and intervertebral fusion were recorded.At the last follow-up,the clinical efficacy was evaluated by Nakai standard.Results The operation time ranged from 90 min to 150 min.Intraoperative bleeding volume was 40~280 ml.The total length of hospitalization time was 8~16 d,and no blood transfusion treatment was given.The 21 cases of wound got primary healing,delayed wound healing occurred in 1 case of diabetes mellitus.There were no complications such as nerve injury and cerebrospinal fluid leakage.Postoperative X-ray reexamination showed that the spodylolisthesis site was reduced.All 22 cases were followed up for 9~18 months.The intervertebral bony fusion were attained within 8~12 months.There was no loosening or rupture of internal fixation.At the last follow-up,the VAS of low back pain was 1~4(2.5±1.1)points,which was significantly different from that of preoperative 5~9(6.3±2.7)points(P<0.05).According to the Nakai criteria,the final follow-up result was excellent in 18 cases,good in 3 and fair 1.The excellent and good rate was 21/22.Conclusions Extraforaminal lumbar interbody fusion combined with pedicle screw internal fixation for degenerative lumbar spondylolisthesis has less trauma and satisfactory effect.