退变性腰椎滑脱症的手术治疗

目的探讨采用后路腰椎椎管减压、钉棒内固定并椎间植骨融合术和后路腰椎减压并Dynesys系统内固定手术治疗退变性腰椎滑脱的效果。方法应用后路腰椎椎间融合（posterior lumbar interbody fusion,PLIF）术进行椎管减压、钉棒系统固定并椎体间植骨融合手术治疗退变性腰椎滑脱37例;应用后路腰椎管减压并Dynesys内固定手术治疗退变性腰椎滑脱5例。结果随访9～39个月,平均26个月,腰痛疼痛视觉模拟量表（visual analogue scale,VAS）评分术前为8.7分,随访时为2.1分;腿痛VAS评分术前为7.6分,随访时为2.3分。术前Oswestry功能障碍指数（Oswestry disability index,ODI）为58.2%,随访时为21.2%。无严重手术并发症发生。术后X线片复查显示椎间高度均得到不同程度的恢复,滑脱椎体完全复位或者基本复位,椎间植骨融合。无融合器移位或螺钉松动、断裂。结论后路腰椎椎管减压、钉棒内固定并椎间植骨融合术和后路腰椎减压并Dynesys内固定手术治疗退变性腰椎滑脱效果满意,安全彻底的神经根管减压是取得满意临床效果的关键。

Surgical treatment of degenerative lumbar spondylolisthesis

Objective To investigate the outcomes of patients with degenerative lumbar spondylolisthesis after treatments by 2 different surgical approaches： ①posterior lumbar spinal nerve canal decompression,reduction and fixation with interbody fusion and ②posterior lumbar spinal nerve canal decompression,fixation with Dynesys.Methods Thirty-seven patients underwent posterior lumbar spinal nerve canal decompression,reduction and fixation with posterior lumbar interbody fusion（PLIF）;5 patients underwent posterior lumbar spinal nerve canal decompression,fixation with Dynesys.Results The mean follow-up time was 26 months（ranging 9-39 months）.The visual analogue scale（VAS）for low-back pain was 8.7 preoperatively and 2.1 during follow-up.The VAS for leg pain was 7.6 preoperatively and 2.3 during follow-up.The Oswestry disability index（ODI）was 58.2% preoperatively and 21.2% during follow-up.The neural compression symptoms were relieved in patients.Postoperative reontgenoghaphs showed that the height of intervertebral space restored to different extents in most cases.No Cage displacement,screw loosening or disruption was found in patients treated by fixation with interbody fusion;and there was no screw loosening in patients treated with Dynesys.Conclusion Both the above mentioned approaches are effective for treatment of degenerative lumbar spondylolisthesis;a thorough decompression is the key for obtaining satisfactory clinical results.