双开窗椎弓根钉内固定加椎间植骨治疗腰椎滑脱症疗效分析  

Effect analysis of lumbar spondylolisthesis by decompressive laminectomy and pedicle screw fixation associated with interbody fusion

作　　者：陈文贵[1] 邓德礼[1] 肖立军[1] 徐晖[1] 

机构地区：[1]广州市番禺区人民医院骨二科,511400

出　　处：《中国实用医药》2009年第12期29-30,共2页China Practical Medicine

摘　　要：目的分析双开窗椎弓根钉内固定加椎间植骨治疗腰椎滑脱症的手术疗效。方法2005年5月至2007年8月,联合采用后路双侧椎板开窗神经根减压、椎弓根螺钉复位固定和椎间植骨融合治疗腰椎滑脱症患者36例,男12例,女24例;年龄36～78岁,平均52.3岁。滑脱性质:峡部裂(真性滑脱)15例,退行性变(假性滑脱)21例。滑脱节段:L31例,L422例,L513例。按照Meyerding分类:I度滑脱23例,Ⅱ度滑脱11例,Ⅲ度滑脱2例。结果36例患者术后均获6～32个月随访。按JOA评分:优28例,良4例,中3例,差1例,优良率为88.9%。术后X线显示所有病例均完全复位或基本完全复位。随访椎间融合好,内固定无松动。结论采用后路双侧椎板开窗神经根减压、椎弓根螺钉复位固定和椎间植骨融合治疗腰椎滑脱症临床疗效理想,能有效地解除了神经卡压,滑脱复位后不容易丢失,植骨融合率高,并发症发生率低,是治疗腰椎滑脱症的理想方法。Objective To analyze the therapeutic effect of decompressive laminectomy and pedicle screw fixation associated with interbody fusion on lumbar spondylolisthesis. Methods From May 2005 to August 2007.36 lumbar spondylolisthesis patients were treated with this operation, including 12 males and 24 females and aging 36-78 years. The affected lumbars were L3 （ 1 cases） ,L4 （22 cases） ,and L5 （ 13 cases）. According to the Meyerding-evaluating system,23 cases were classified as degree Ⅰ,11 eases as degree Ⅱ ,and 2 cases as degree Ⅲ. Results All patients were followed up 6-32 months. According to the Japanese Orthopaedic Association （JOA） scores the results were excellent in 28 cases,good in 4 cases,fair in 3 cases and bad in l case. The excellent and good rate was 88.9%. All of the embedded osseous were fused. There were no breakage of screw and rod. The position and configuration of the whole cages were good. Conclusion Applying decompressive lamineetomy and pedicle screw fixation associated with interbody fusion may achieve synergism in the treatment of lumbar spondylolisthesis. Above procedure is served as solid internal fixation and offers a satisfactory＇ reduction, can improve the fusion rate of the spine and may decrease the complications such as broken screw and spondylolisthesis reeurrency postoperatively. So it is an ideal procedure for treatment of lumbar spondylohsthesis.

关 键 词：椎板开窗 椎弓根螺钉系统 椎间融合器 腰椎滑脱症 

分 类 号：R687.3[医药卫生—骨科学]