重度腰椎滑脱症固定融合节段范围探讨  

Fixation and Fusion Segments for High-grade Lumbar Spondylolisthesis

作　　者：徐练[1] 周忠杰[1] 杨进[1] 孔清泉[1] 刘立岷[1] 曾建成[1] 刘浩[1] 宋跃明[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《华西医学》2015年第8期1420-1425,共6页West China Medical Journal

摘　　要：目的 分析经后路复位治疗的重度腰椎滑脱症患者的病历资料,探讨重度腰椎滑脱症的最佳固定节段范围。方法 回顾性分析2007年7月-2012年3月收治的21例重度腰椎滑脱症患者。所有患者均行后路椎管减压、双向Schanz钉固定并复位滑椎、椎间及后外侧植骨融合结合“不稳定区”概念与脊柱畸形的特点综合判断固定融合范围。对比并分析手术前后椎体滑脱程度、骨盆入射角（PI）、腰骶角及脊柱冠状面畸形情况。临床体检、神经肌电图评价患者神经功能状况。疼痛视觉模拟评分（VAS）及功能障碍指数分别评估患者手术前后临床及下肢功能活动状况。三维CT评价植骨融合情况。结果 21例患者均获随访,随访时间12-48个月。术后12个月随访时,所有患者的临床及影像学观察指标如VAS评分、PI角等较术前均有明显改善,差异有统计学意义（P〈0.05）。结论 对于儿童重度腰椎滑脱,如未合并结构性脊柱侧凸畸形,建议固定融合至PI角〉60°的上端椎,并尽量保护相应节段脊柱后方韧带复合体,预防相邻节段出现节段性不稳或滑脱。对于成人重度腰椎滑脱,如未合并其他脊柱疾患,复位滑椎后可采用单节段固定融合;如滑脱未复位,建议采用双节段或多节段固定融合。Objective To explore a better segment of fixation and fusion for high-grade spondylolisthesis. Methods A total of 21 patients with high-grade spondylolisthesis who had undergone reduction and posterior instrumented fusion between July 2007 and March 2012, were retrospectively reviewed. All cases underwent posterior spinal canal decompression, Schanz screws fixation and reduction, and intervertebral and posterolateral fusion. The concept of ＂unstable zone＂ and the feature of spinal deformity helped us to identify the most appropriate segment to fuse. The pre/post-operative differences on slip percentage, pelvic incidence （PI） and lumbosacral angle were compared and analyzed. The nerve function was evaluated by physical examination and neurological Frankel grade. The Visual Analogue Scale （VAS） and Oswestry Disability Index were used to assess clinical and functional outcomes of lower limbs. Bone fusion was assessed using CT reconstruction. Results All patients were followed up between 12 and 48 months. The clinical and radiological outcomes such as VAS scores and PI angle were all improved compared with that of preoperative, and the differences were all statistically significant （P 〈 0.05）. Conclusions For children with severe spondylolisthesis, if not combined with structural scoliosis, the fixation and fusion level should be up to the upper vertebra which PI angle 〉 60 °, and try to protect the posterior longitudinal ligament complex in case adjacent segments become instability or even slip. For adults with severe spondylolisthesis, if not combined with other spinal disorders such as severe osteoporosis, only mono-segmental fusion is recommended after reduction. If the slipped vertebrae could not be reduced to Meyerding grade I, two or more segments would need to be fixed and fused.

关 键 词：重度腰椎滑脱症 后路 复位 固定融合节段 

分 类 号：R687.3[医药卫生—骨科学]