短节段椎弓根螺钉后路椎间植骨治疗重症峡部裂型腰椎滑脱症  

Short-segment pedicle screw system with posterior lumbar interbody fusion for severe isthmic spondylolisthesis

作　　者：刘少华[1] 张宏其[1] 陈斌[2] 郭超峰[1] 陈凌强[1] 葛磊[1] 刘金洋[1] 王锡阳[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湘雅脊柱外科中心,长沙410008 [2]湖南省郴州市第一人民医院脊柱外科,郴州423000

出　　处：《中国矫形外科杂志》2010年第3期177-180,共4页Orthopedic Journal of China

基　　金：“十一五”国家科技支撑计划项目(编号:2007BAI04B07)

摘　　要：[目的]探讨应用短节段椎弓根螺钉系统内固定并后路椎间植骨融合治疗重症峡部裂型腰椎滑脱症的疗效和手术技巧。[方法]2005年1月～2007年1月,对51例重症峡部裂型腰椎滑脱患者行短节段椎弓根螺钉后路椎间植骨融合术,年龄25～67岁,平均41岁;术前滑脱程度按Meyerding分级标准均大于33%,平均为42%,均有不同程度的神经根受损症状。通过术前、术后脊柱正、侧位X线片和Beaujon functional score(BFS)评分,分析临床疗效,评价治疗效果。[结果]51例患者均获随访,随访时间为2～3年10个月,平均2年8个月。术后平均滑脱复位率92%;椎间隙高度由术前平均4.9 mm恢复至术后的10.3 mm;植骨融合率100%,平均融合时间4个月;BFS评分由术前平均8.1分升至术后2年的17.9分,疗效优良率为91%。随访期间滑脱复位率、椎间隙高度无明显丢失。[结论]短节段椎弓根螺钉系统内固定后路椎间植骨融合术可以用于治疗重症峡部裂型腰椎滑脱症,能保留更多的腰椎运动单元。[Objective]To investigate the curative effect and surgical techniques of short-segment pedicle screw system（PSs） with posterior lumbar interbody fusion（PLIF） for severe isthmic spondylolisthesis.[Methods]From January 2005 to January 2007,a consecutive series of 51 patients with severe isthmic spondylolisthesis were managed by short-segment PSs and PLIF.The mean age at time of surgery was 41 years（range,from 25 years to 67 years）.According to Meyerding grade,the preoperative percentage of spondylolisthesis was above 33% in all cases,with an average of 42%.All patients were radiculopathic.The percentage of spondylolisthesis and disc height were analyzed to determine the effectiveness by measuring the data from the standing anterior-posterior and lateral radiographs,which were taken before surgery,in the postoperative period,and at last follow-up.The Beaujon functional score was assessed for each patient before surgery and at last follow-up.[Results]The average time of follow-up was 2 yea...更多rs and 8 months（range,from 2 years to 3 years and 10 months）.There was a mean improvement of 92% for reduction rate of spondylolisthesis.The disc height improved from 4.9 mm to 10.3 mm on the average.All patients got bony fusion of the fixation segments within 4 months.The mean Beaujon functional score increased from 8.1 before surgery to 17.9 two years after surgery and the rate of excellent and good results was 91%.In the time of follow-up,no significant loss of spondylolisthesis reduction rate and disc height occurred.[Conclusion]Short-segment PSs with PLIF has a good effectiveness in the treatment of severe isthmic spondylolisthesis.It provides short segmental fusion to preserve more lumbar mobile segments.

关 键 词：重症峡部裂型腰椎滑脱 短节段内固定 椎弓根螺钉 复位 后路椎间植骨融合 

分 类 号：R687.3[医药卫生—骨科学]