腰椎椎弓峡部裂伴椎体Ⅱ°或以上滑脱的手术治疗策略
曾忠友, 严卫锋, 唐宏超, 吴鹏, 张建乔, 金才益
中国临床解剖学杂志 ›› 2013, Vol. 31 ›› Issue (5) : 591-595.
腰椎椎弓峡部裂伴椎体Ⅱ°或以上滑脱的手术治疗策略
Surgery strategy of isthmic lumbar spondylolisthesis of grade Ⅱ or above
目的 探讨腰椎椎弓峡部裂伴椎体Ⅱ°或以上滑脱的有效的手术治疗方法。 方法 回顾性分析我院2006年1月～2011年6月采取手术治疗、且资料完整的42例腰椎椎弓峡部裂伴椎体Ⅱ°或以上滑脱病例。男13例，女29例，年龄24～70岁，平均51.0岁，病史时间2 ～20年，平均7.5年，均有顽固性下腰痛；病变部位：L4 15例，L5 27例；均为双侧椎弓峡部裂，其中椎体滑脱Ⅱ°28例，Ⅲ°14例。均采用椎弓根螺钉复位固定并椎间融合器植骨术，其中单节段固定38例，双节段固定4例。经椎间孔入路融合器植骨，使用一枚融合器5例，使用两枚融合器37例。对比其术前、后腰椎前凸角、骶倾角、滑脱角、滑脱率和椎间隙高度的变化，采用Oswestry评分(ODI)评价其功能变化。 结果 本组病例切口无感染，1例因螺钉位置不正确术后出现神经根损伤症状而行螺钉调整术。均获得随访，随访时间12～48个月，平均 28.5个月。除腰椎前凸角手术前后无明显变化外，术后滑脱角、滑脱率、骶倾角和椎间隙高度均获得良好的改善。本组未出现内固定松动、断裂及融合器移位现象，椎间融合器植骨除2例不能明确外，其余均获骨性融合；Oswestry评分由术前33.6±6.5至最后随访时10.8±4.1。 结论 腰椎椎弓峡部裂伴椎体Ⅱ°或以上滑脱病例其病史时间长、病情重、病理变化明显。建议单节段椎弓根螺钉复位固定、充分松解、尽量复位并采用椎间融合器植骨方法。
Objective To analyze effective methods of surgery for isthmic lumbar spondylolisthesis of grade Ⅱ or above. Methods From January 2006 to June 2011, 42 patients with a mean age of 51 years (range, 24 to70 years) with isthmic lumbar spondylolisthesis of grade Ⅱ or above treated with pedicle screw fixation and interbody fusion, including 13 males and 29 females, were reviewed retrospectively. Isthmic defects were located at L4 in 15 cases, at L5 in 27 cases.28 cases were in grade Ⅱ spondylolisthesis and 14 cases in Ⅲ. The clinical outcome were evaluated according to Oswestry disability index(ODI) and the change of radiographic data. Results All cases had got complete follow-up for 12~48 months (average 28.5 months). In one case, the internal instrument was adjusted because of nerve root injury caused by screw malposition. There was no complication such as incision infection and instrument failure. Post-operatively, the slipping degree was reduced, the height of intervertebral space increased and slipping angle decreased. The radiographic data had no obvious loss in the final follow-ups. Bony fusion was solid in 40 cases, but poor in 2 cases. The objective clinical outcomes of the ODI were in average 33.6±6.5 before operation and 10.8±4.1 after operation. Conclusion There are characteristics in isthmic lumbar spondylolisthesis of grade Ⅱ or above, such as long time medical history, severe patient's conditions and obvious pathological change. It is recommended that Mono-segment fixation, sufficient relaxation, maximal restoration, and interbody cage insertion be adopted for treatment of isthmic lumbar spondylolisthesis of grade Ⅱ or above , which canachieve rigid fixation and fusion.
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