【摘要】 目的总结短节段钉棒复位"掀盖"回植式360°融合治疗峡部裂型腰椎滑脱的临床疗效。方法 2004年10月-2008年3月,对44例峡部裂型腰椎滑脱患者采用后路"掀盖"、腰椎管减压、短节段椎弓根钉棒复位内固定,椎板回植式360°融合术治疗。其中男15例,女29例;年龄28～45岁,平均38.4岁。病程14个月～7年,平均38个月。滑脱按Meyerding分级:Ⅱ度28例,Ⅲ度16例。L4、5滑脱18例,L5、S1滑脱26例。对所有患者手术前后行腰腿痛视觉模拟评分(VAS)、Oswestry功能障碍(ODI)评分、简明健康状况调查表(SF-36)评分,并根据影像学检查结果测定滑脱率、椎间隙及椎间孔高度、植骨融合率,评价临床及影像学治疗效果。结果所有患者均获随访,随访时间20～60个月,平均42个月。末次随访时的腰腿痛VAS评分、ODI评分、SF-36评分均较术前显著改善(P<0.05)。Morelos总体疗效评估:优32例,良9例,可3例,优良率为93.2%。术前滑脱率平均47.5%,术后3d滑脱率平均2.6%,平均复位率达97.4%,末次随访时复位无明显丢失。术后椎间隙高度和椎间孔高度均较术前显著增加(P<0.05),术后3d与末次随访时比较差异无统计学意义(P>0.05)。X线片及CT三维重建显示所有患者均在术后1年内获得骨性融合,融合率100%。发生髂骨取骨区疼痛4例、切口浅表感染2例、硬膜撕裂1例、融合相邻节段退变2例,均经对症处理后治愈。无神经损伤、明显假关节形成、内固定失败及术后椎管再狭窄等并发症发生。结论短节段钉棒复位"掀盖"回植式360°融合是治疗峡部裂型腰椎滑脱的一种可靠方法,临床疗效满意,融合率高且并发症少,但远期疗效有待进一步随访分析。更多还原

【Abstract】 Objective To evaluate the mid-term clinical outcome of instrumented slip reduction combined with 360° circumferencial fusion and restoration laminae for symptomatic adult isthmic spondylolisthesis. Methods Between October 2004 and March 2008, 44 patients with symptomatic isthmic spondylolisthesis underwent instrumented slip reduction combined with 360° circumferencial fusion and restoration laminae. There were 15 males and 29 females with an average age of 38.4 years (range, 28-45 years). The disease duration was 14 months to 7 years (38 months on average). The a ected vertebrae was L4-5 in 18 patients and L5, S1 in 26 patients. According to Meyerding’s grade for spondylolisthesis, 28 cases were rated as grade II and 16 as grade III. The visual analogae scale (VAS), Oswestry disability index (ODI), and the short form 36 health survey (SF-36) scores were evaluated before operation and at last follow-up; the radiographical outcome was evaluated by measuring slipping percentage, heights of intervertebral space and foramen, and fusion rate. Results All patients were followed up 20-60 months (42 months on average). The VAS, ODI, and SF-36 scores were all signi cantly improved at last follow-up when compared with those before operation (P < 0.05). According to Morelos criteria, the clinical results were excellent in 32 patients, good in 9, and fair in 3; the excellent and good rate was 93.2%. The preoperative average percentage of slip was 47.5%, which was improved to 2.6% 3 days after operation; the total average reduction rate was 97.4%, and it was maintained at last follow-up. The heights of intervertebral space and foramen were all improved signi cantly after operation (P < 0.05), and there was no signi cant di erence between at 3 days after operation and at last follow-up (P > 0.05). X-ray and CT showed bony fusion 1 year after operation in all patients with a fusion rate of 100%. Complications included pain at donor site of iliac bone in 4 cases, super cial infection in 2 cases, dural tear in 1 case, and degeneration of adjacent vertebrae in 2 cases; no nerve root injury, pseudoarthrosis, failure of internal xation, and acquired spinal canal stenosis occurred. Conclusion Instrumented slip reduction combined with 360° circumferencial fusion and restoration laminae is a reliable procedure for adult isthmic spondylolisthesis with satisfactory mid-term results, a high fusion rate and low complication rate. The long-term outcomes should be veri ed by follow-up in the future.更多还原