椎弓根螺钉置入内固定与单纯椎管减压治疗退行性腰椎滑脱的比较

背景：随着脊柱内固定和脊柱融合技术的发展,脊柱融合已成为腰椎退行性滑脱症毫无争议的＂金标准＂。同时,邻近节段退行性变的问题引起人们越来越多的关注。目的：观察椎弓根螺钉内固定置入植骨融合治疗退行性腰椎滑脱的临床疗效、手术节段稳定性及其对相邻节段的影响,并与单纯椎管加压进行对比。方法：选择天津医科大学总医院骨科收治的退行性腰椎滑脱患者38例,排除失访3例,余35例中采用椎弓根固定后外侧融合21例,单纯椎管减压14例。单纯椎管加压组用咬骨钳咬除黄韧带和椎板解除神经根后方的压迫,用骨凿凿除向前滑脱的椎体后缘与下位相邻椎体后缘形成的相对性突起;椎弓根螺钉固定植骨融合组按Wein-stein法定位椎弓根钉进针,拧入椎弓根螺钉,根据受压情况进行椎板减压。按Oswestry功能障碍指数综合评价临床疗效,观察过伸、过屈位时的水平位移及角移位,采用UCLA系统来评价邻近节段退变情况。结果与结论：35例患者随访时间1年。椎弓根螺钉固定植骨融合组优良率显著高于单纯椎管加压组（P〈0.05）。椎弓根螺钉固定植骨融合对腰椎稳定性影响不大,邻近节段退变置入前和置入后1年无明显变化。单纯椎管加压对腰椎稳定性影响显著,同时治疗前和治疗后1年邻近节段退变无明显变化。提示椎弓根螺钉内固定置入植骨融合治疗退行性腰椎滑脱疗效满意,对腰椎稳定性影响小,并且置入后早期对椎间盘的邻近节段影响不大。

Comparison of pedicle screw fixation and simple vertebral canal decompression in the treatment of lumbar degenerative spondylolisthesis

BACKGROUND：With the development of spinal internal fixation and spinal fusion technology,spinal fusion has become undisputed ＂gold standard＂ of lumbar degenerative spondylolisthesis.Meanwhile,the problem of adjacent segment degeneration attracts more and more attention.OBJECTIVE：To observe the clinical effect,the stability of surgical segment,and their influences on adjacent segments of pedicle screw fixation and fusion in treatment of degenerative spondylolisthesis,and to compare with simple vertebral canal compression.METHODS：A total of 38 patients with lumbar degenerative spondylolisthesis received treatment at the Department of Orthopaedics,General Hospital of Tianjin Medical University were selected,and 3 patients were lost in follow-up.Of the remaining 35 cases,21 cases underwent pedicle screw fixation posterolateral fusion and 14 cases underwent simple vertebral canal decompression.Simple vertebral canal compression group treated with the rongeur bite yellow ligament and lamina to relieve nerve root compression,forward vertebral slippage of adjacent vertebral body with posterior inferior formation relative prominence was chiseled with osteotome.According to Wein-stein method pedicle screw into the needle localization,then screw into the pedicle screw and undergo vertebral plate decompression on the basis of compression condition in pedicle screw fixation and fusion group.The clinical effect underwent comprehensive evaluation of oswestry dysfunction index;horizontal displacement and angular displacement were observed at hyperextension and flexion time.Degenerative condition of adjacent segment was evaluated by UCLA system.RESULTS AND CONCLUSION：A total of 35 patients were followed up for 1 year.The excellent rate in pedicle screw fixation and fusion group was significantly higher than that in simple vertebral canal compression group （P0.05）.Pedicle screw fixation and fusion has little effect on the stability of lumbar.There was no significant change in adjacent segment before degenerative insertion and 1 year after insertion.Simple vertebral canal compression had a significant effect on the stability of lumbar,and there was no significant change in adjacent segment degeneration before treatment and 1 year after treatment.It is indicated that pedicle screw fixation and fusion has satisfying effects in treatment of degenerative spondylolisthesis,and has less influence on stability of lumbar,which has little effect on adjacent segments of intervertebral discs after insertion in early stage.