椎弓根钉固定联合PLIF手术治疗多节段腰椎滑脱的疗效分析

目的探讨椎弓根钉棒系统复位固定联合椎间植骨融合（posterior lumbar interbody fusion,PLIF）手术治疗多节段腰椎滑脱症的临床疗效。方法选择2004年9月至2011年9月共18例多节段腰椎滑脱的患者,其中男8例,女10例;年龄38～64岁,平均52.2岁。12例为L3～5滑脱,6例为L4～S1滑脱。患者均接受腰椎后路椎管减压,椎弓根钉棒系统复位固定,椎间植骨融合术。术前术后行腰腿痛视觉模拟评分（visual analogue scale,VAS）及腰椎日本骨科协会评估治疗分数（Japanese orthopaedic association,JOA）评估临床功能恢复情况,Lenke标准评价脊柱植骨融合情况。结果术后共完成随访17例,30个节段完全复位。VAS评分由术前（8.0±1.0）分降至末次随访（1.0±1.0）分,二者比较差异有统计学意义（P〈0.05）;JOA评分由术前（8.9±2.4）分增至末次随访时的（24.8±2.7）分,二者比较具有统计学意义（P〈0.05）;植骨融合结果：Lenke A级13例,B级4例。结论腰椎后路椎管减压、椎弓根钉棒系统复位固定联合椎间植骨融合术治疗多节段腰椎滑脱症疗效满意,该术式能使滑脱节段获得良好的复位、固定,并具有较确切的融合率。

Pedicle Screw Fixation Combined with PLIF in Treating Multi-level Lumbar Spondylolisthesis

Objective To investigate the clinical effect of pediele screw fixation combined with PLIF in treating multi-level lumbar spondylolisthesis. Methods 18 patients （8 male and 10 female,age range..38~64,mean age：52.2） multi-level lumbar spondylolisthesis （12 L3-5,6 L4～1 ）,were enrolled in this study. All the patients received posteri- or spinal canal decompression,pedicle screw fixation and intervertebral fusion. The clinical effect was evaluated by VAS score,JOA score and Lenke standard system. Results Follow up was completed in 17 patients. 30 segments achieved complete reduction of lumbar spondylolisthesis. VAS score decreased significantly （P（0. 005,post-opera- tion ： 8.0±1.0 ; final follow-up ： 1.0±1.0）. JOA score increased significantly （P〈0. 005, post-operation ： 8.9 ±2.4 ; fi- nal follow up：24.8±2.7）.For bone fusion：grade A：13 patients,grade 13：4 patients ）. Conclusion Lumbar posterior spinal canal decompression,pediele screw and rod system fixation and intervertebral fusion can provide successful in- terbodv fusion and satisfactory clinical results.