【作者】 王清； 王松； 钟德君； 王高举； 文睿；

【Author】 WANG Qing,Wang Song,Zhong Dejun,et al.Department of spinal surgery,Affiliated Hospital of Luzhou Medical College,Luzhou 646000,China

【机构】 泸州医学院附属医院脊柱外科；

【摘要】 目的观察局部自体骨移植治疗峡部裂性腰椎滑脱症（Adult isthmicspondylolisthesis,AIS）的临床疗效。方法2004年7月-2008年12月我院收治没有明显骨质疏松的AIS患者41例,采用术中切除的滑脱椎棘突、椎板、关节突行椎间支撑植骨融合及非万向椎弓根螺钉系统固定。随访观察该组患者临床疗效。结果本组患者均采用四钉二棒的非万向螺钉系统行单节段融合:L_3,4 2例,L_4,5 23例,L₅S₁ 16例。合并滑脱椎相邻节段椎间盘突出、椎间不稳定及椎管狭窄需行开窗减压神经根探查者均不予固定融合7例。手术时间2.5-3.5小时,出血量200-800ml,平均320ml。术中置钉时发生钉道破裂3次。术中发生硬膜囊破裂3例,神经根袖破裂2例。随访3月-4年,平均2.3年33例,腰背痛明显减轻28例,腿痛减轻或消失16例,残余肢体麻木3例,足背伸肌力Ⅲ-Ⅳ级2例,腰椎疾患JOA评分由术前13.3±4.0分恢复到末次随访时26.6±3.3分。X片示椎间植骨融合良好29例;滑脱复位有部分丢失3例,植骨块脱出于椎体后缘1例,钉棒系统断裂1例。结论局部自体骨移植结合非万向椎弓根螺钉系统牢固固定,取材和植入方便,来源丰富是AIS患者椎间融合方法之一。更多还原

【Abstract】 Objective:To observate clinical effects using local self-lamina autograft about adult isthmic spondylolisthesis(AIS).Method:41 patients who had AIS without obvious osteoporosis were operated by local self-lamina autograft(inclued spinions, lamina and facet) harvested from slipping vertebrae and no-multioriention pedicel screw devices.Clinical resulting were followed.Result:A total of 41 patients were operated smoothly operation time 2.5~3.5 hours and arerage 3 hours,estimated blood loss were 200~800 average 320ml.3 pedicle fracture taken place intraoperation 5 cases had CSF leak,33 patient were followed from 3 months to 4 years and average 2.4 years. Relief of lower back pain in 28 cases,14 cases had relief of the lower leg and buttocks pain,calf numbness existed in 3 cases dorsal foot hypesthesia in 2 cases.The mean neurological score according to JOA improved from 13.4±4.0 before operation to 26.6±3.3 at last follow,good intervertebrae fusion had happened in 29 cases pyuedarthrosis was suspected in 2 cases.Part loss of slipping vertebral reduction were in 2 cases,graft mass shifted posterior edge of the intervertesrial space in 1 case,screw-rod instrumention had loosing and broken in 2 case.Conculsion:One of the good fusion way in PLIF for AIS is local autograft and rigid pedicle screw fixation because of convenance of harvesting and inserting fusion material.更多还原