【摘要】 目的:探讨脊髓造影对腰椎滑脱症患者手术方法选择的意义。方法:对43例腰椎滑脱症患者术前行脊髓造影检查,根据患者症状、体征及脊髓造影检查结果采用三种不同的手术方法:(1)脊髓造影显示椎管通畅、神经根充盈良好者采用后路椎弓根内固定,椎板、横突间植骨,共11例;(2)脊髓造影显示一侧神经根充盈欠佳,椎管部分狭窄,进行切开复位、内固定,症状侧半椎板减压或神经根管扩大加横突间小关节突外侧植骨,对侧椎板、横突间植骨,共10例;(3)脊髓造影表现椎管完全梗阻,双侧神经根充盈欠佳,进行切开复位、内固定,全椎板减压和神经根管扩大,横突间小关节突外侧植骨或加椎间融合,共22例。结果:所有患者均获得随访,随访时间12～28个月,平均19.1个月,神经功能评定按照JOA评分标准,术后神经功能改善率76%。参考侯树勋等疗效评价标准,临床优良率为86.1%。结论:脊髓造影对腰椎滑脱症患者椎管减压、植骨方式的选择有重要参考价值。更多还原

【Abstract】 Objective: To analyse the significance of myelography used in selecting the operation methods for spondylolisthesis.Method:43 patients with lumbar spondylolisthesis were ordered to perform myelography.According to the clinical findings,signs and the outcomes of myelography,all of the patients were divided into 3 groups.GroupⅠ consisted of 11 patients of grade Ⅰ spondylolisthesis with back pain or intermittent claudication.Myelography showed no spinal stenosis or lateral canal stenosis and they were treated with reduction of slided vertebra used posterior pedicle screw fixation,interlaminar bone grafting fusion.Group Ⅱ consisted of 10 patients with unilateral sciatica,myelography showed lateral canal stenosis and they were treated with semi-laminectomy decompression,medial facetectomy,foraminotomy in symptomatic side,slided vertebra were reduced by pedicle screw fixation,interlaminar fusion in symptomatic side and transverse process fusion in contral lateral side.Group Ⅲ consisted of 22 patients with biolateral sciatica,neurogenic claudication,motor weakness or sensory disturbance in the nerve root distribution.Myelography showed part or complete canal block,spinal stenosis and they were treated with laminectomy decompression,medial facetectomy,foraminotomy,reduction and fixation of slided vertebra with pedicle screw instrument,posterior transverse process bone graft or intervertebral body fusion.Result:The results were evaluated after follow-up 12 to 28months in 43cases.The satisfactory rate reached 86.1%.Recovery rate of clinical nervous results was 76%.Conclusion:Myelography is a very useful examination to evaluate spinal stenosis or lateral canal stenosis due to anterior slippage of the vertebral column and fibrocartilagenous mass of spondylolisthesis.更多还原