后路椎弓根固定270°椎间融合治疗腰椎滑脱
后路椎弓根固定270°椎间融合治疗腰椎滑脱 后路椎弓根固定 270 椎间融合治疗腰椎滑脱 作者: 常山, 刘战立, 蒋华, 白琛, 严小虎, 田家亮, 查晓霞 【摘要】 目的 探讨经后路单侧后外侧融合基础上, 单枚 BAKcage斜向置入或后路椎体间植骨融合的 270 融合治疗峡部裂型腰椎滑脱症的临床疗效。 方法 2004 年 8 月至 2007 年 8 月, 对 19 例峡部裂型腰椎滑脱按 Meyerding 分度, Ⅰ 度滑脱 12 例, Ⅱ 度滑脱 7 例, 分别采纳椎弓根螺钉复位固定单侧后外侧融合并单枚 cage 椎体间融合(A组) 或椎弓根螺钉复位固定单侧后外侧融合并椎体间植骨融合(B 组)两种 270 融合方法治疗。 结果 19 例病人术后随访时间 12~24个月,平均 18 个月。 JOA 评分总体满足率为 95%, 其中 A 组为 100%, B 组为91. 7%, 两者无显著性差异。 19 例病人均完全复位, 随访复位无明显丢失。 全部病人均无内固定松动断裂、 cage 明显后移沉降和神经根及马尾损伤等并发症。 全部病人术后 1 年随访均获得骨性愈合。 最终随访椎间隙高度平均削减 1. 2 mm, B 组较 A 组明显。 结论 两种后路 270植骨融合方式加椎弓根螺钉复位固定治疗峡部裂型腰椎滑脱对后柱破坏少, 具有较高稳定性, 均能获得满足疗效并能明显降低内固定松动断裂和复位丢失率, 提高脊柱融合率。 【关键词】 腰椎滑脱症; 椎间融合器; 椎弓根螺钉; 后路椎体间植骨融合 Abstract: Objective To compare the outcome of lumbar isthmus spondylolisthesis treated with vertebral arch screw reduction fixation, posterior lumbar interbody fusion(PLIF) with mono cage or treated with posterior lumbar interbody fusion by bone graft. s From Aug 2004 to Aug 2007, 19 cases of grade Ⅰ or Ⅱ lumbar isthmus spondylolisthesis were treated with vertebral arch screw reduction fixation, mono posterolateral fusion. Among them 7 cases were treated with posterior lumbar interbody fusion(PLIF) by mono cage(groupA) and 12 cases were treated with posterior lumbar interbody fusion by bone graft(group B) . Results 19 cases were followed up at a mean time of 18 months(range 12 to 24 months) post operation. The excellent and good result rate of JOA score in group A and B was 100% and 91. 7% respectively, there were no significant difference in the JOA score between two groups. The total excellent good result rate and fusion rate was 95% and 100% respectively. No screw breakage or internal fixation loosening were found and no loss of spondylolisthesis reduction or nerve root and cauda equine injury were found post operation. Cage position retrusion and subsidence were not found either. At the last follow up ,the average loss of intervertebral height was 1. 2 mm and group B was more severe than group A. Conclusion Two s of posterior lumbar interbody fusion with 270 angle are very effective to lumbar isthmus spondylolisthesis and can provide good stability with minimal damage. It can also improve the fusion rate, decrease internal fixation loosening and loss of reduction. Key words: lumbar spondylolisthesis; cage; pedicle of lumbar vertebra screw; posterior lumbar interbody fusion 腰椎滑脱是临床上常见的一类脊柱疾患, 常见病因有退变和峡部裂型两种。 峡部裂型腰椎滑脱可引起明显腰椎管狭窄和腰椎间盘变性突出, 导致严峻下腰痛和神经根痛, 严峻时造成马尾神经损害,患者出现大小便功能障碍。 我院对峡部裂型腰椎滑脱的治疗经验了从节段性经横突或椎弓 根螺钉复位钢丝内 固 定后外侧植骨 融合术(posterolateral fusion, PLF) , 到 RF 椎弓根螺钉提拉复位内固定后外侧植骨融合术, 发觉其融合率不高, 复位和椎间隙高度简单丢失,且易出现内固定松动和断裂。 近年来峡部裂型腰椎滑脱的融合观念从单一的后外侧 180 融合过渡到经后路行前方椎体间融合(posterior lumbar interbody fusion, PLIF) 的 360 融合, 并取得了满足的效果[1]。 作者 3 年间对 19 例峡部裂型腰椎滑脱症在后路椎弓根螺钉 RF复位固定并单侧后外侧融合的基础上分别采纳单枚 BAKcage 斜向置入椎体间融合(A组) 和单纯椎体间植骨融合(B组) 两种 270 融合方法治疗[2], 均取得满足效果, 现报道分析如下。 1 临床资料