腰椎滑脱症手术治疗的临床分析  

Clinical study of different surgical procedures for the treatment of lumbar spondylolisthesis:clinical analysis on 82 cases

作　　者：秦之威[1] 孙磊[2] 陈晓亮[3] 张杰峰[1] 夏波[1] 

机构地区：[1]泰安市中心医院骨科,山东271000 [2]中国人民解放军第88医院骨科 [3]青岛大学青岛医学院附属医院骨科,青岛266003

出　　处：《中国矫形外科杂志》2006年第11期821-824,共4页Orthopedic Journal of China

摘　　要：[目的]通过对82例腰椎滑脱症手术治疗病人的回顾性临床分析，探讨有关腰椎滑脱症的手术适应证、术式选择及治疗效果。[方法]依据病人情况分别采取以下4种术式：A组，后路单纯植骨融合术18例，均Ⅰ度滑脱；B组，椎弓根钉固定复位椎板间植骨融合术31例，Ⅰ度11例，Ⅱ度20例；C组，减压、椎弓根钉固定复位横突间植骨融合术19例，Ⅰ度2例，Ⅱ度13例，Ⅲ度4例，包括椎间盘突出3例，椎管狭窄3例；D组，减压、椎间融合、椎弓根钉固定复位横突间植骨融合术14例，Ⅰ度1例，Ⅱ度10例，Ⅲ度3例，包括椎管狭窄6例（Ⅰ度1例、Ⅱ度4例、Ⅲ度1例），椎间盘突出4例（Ⅱ度3例、Ⅲ度1例）。[结果]随访6个月～6a 6个月，平均3a8个月，单纯植骨融合组（A组）18例中15例融合，其融合率83％、滑脱复位率0．03％，根据下腰痛的FRS评分标准，其改善率52．69％。椎弓根钉固定复位椎板间植骨融合（B组）的31例中30例融合，其融合率96％，滑脱复位率83％，改善率56．20％。减压、椎弓根钉固定复位横突间植骨融合组（C组）融合率89％、滑脱复位率90％、改善率59．85％。减压、椎间融合、椎弓根钉固定复位横突间植骨融合组（D组）融合率100％、滑脱复位率92％、改善率61．08％。[结论]不同的手术方式针对不同的手术适应证。手术方式的不同因病人的病情不同而不同。[ Objective] Through the analysis of 82 cases of spondylolisthesis treated with surgery, the different types of surgical procedures were evaluated. [ Method] Patients with spondylolisthesis were divided into 4 groups based on their pathology and different surgical procedures were used accordingly. Group Ⅰ consisted of 18 patients with degenerative spondylolisthesis with back pain （3 cases） and isthmic spondylolisthesis （13 cases） and traumatic spondylolisthesis （2 cases） of Ⅰ degree; They were treated with posterior interlaminar and interspinous process fusion; Group Ⅱ consisted of 31 cases with degenerative spondylolisthesis （2 cases） and isthmic spondylolisthesis （23 patients） and traumatic spondylolisthesis （6 cases） of Ⅰ degree （ 11 cases） and Ⅱ degree （20 cases） ; They were treated with reduction of sliding vertebra and posterior interlaminar and interspinous process fusion; Group Ⅲ consisted of 19 cases with degenerative spondylolisthesis （2 cases） and isthmic spondylolistbesis （17 cases） of Ⅰ degree （2 cases）, Ⅱ degree （13 cases） and Ⅲ degree （4 cases）; They were treated with laminectomy and decompression, with reduction of sliding vertebra and transverse process fusion; Group Ⅳ consisted of 14 cases with isthmic spondylolisthesis of Ⅰ degree （ 1 case）, Ⅱ degree （ 10 cases） and Ⅲ degree （3 cases） ; They were treated with laminectomy and decompression, with intervertebral body fusion, with reduction of sliding vertebra and transverse process fusion. [ Result] In group Ⅰ , solid fusion were in 15 cases giving a fusion rate of 83% , 0. 03% rate of reduction, 52.69% rate of improvement; In group Ⅱ , solid fusion were in 30 cases giving a fusion rate of 96% , 56. 20% rate of improvement, 83% rate of reduction; In group Ⅲ, fusion rate, reduction rate and improvement rate reached 89%, 90%, 59. 85% respectively; In group Ⅳ, the fusion rate, reduction rate and improvement rate were as high as 100% , 92% , 61.08% respec

关 键 词：腰椎 椎体滑脱 手术方法 适应证 疗效 

分 类 号：R687.3[医药卫生—骨科学]