后路手术治疗重度腰椎滑脱疗效观察_临床医学论文.docVIP

后路手术治疗重度腰椎滑脱疗效观察_临床医学论文 后路手术治疗重度腰椎滑脱疗效观察_临床医学论文 作者：徐杨博，阳运康，尹一然，叶里子，鲁晓波，唐炼【摘要】 　　目的 观察采用SRS型椎弓根螺钉复位内固定系统一次手术完成减压复位及椎间植骨融合内固定治疗重度腰椎滑脱的疗效。方法 对13例患者全部采用后路双侧小关节及椎板切除彻底减压，SRS型椎弓根螺钉系统复位固定， 一次手术完成减压复位及椎间植骨融合内固定，其中10例采用椎间植骨融合器，3例采用整块髂骨植骨。结果 术后13例全部达到解剖复位，无感染。除1例术后出现暂时性L5及S1神经根牵拉症状外，余无神经系统功能恶化表现。所有病人原有症状均获得不同程度改善，其中优9例，良3例，可1例。本组随访时间为3月～42月，平均13个月。随访中患者情况稳定，症状体征改善明显。X线片显示椎间植骨融合良好，螺钉无折断，无其它远期并发症。结论 在重度滑脱的治疗中，应走出传统减压复位的误区，一次进行以小关节为中心的彻底减压及完全复位，免除患者二次手术的痛苦，也为解决临床治疗中的难点提供了一种新的治疗方法。 【关键词】 脊椎滑脱 减压 脊柱融合术 　　Abstract Objective To observe the curative effect of the posterior operation with SRS pedicle screw for reduction internal fixation and bone grafting fusion in patients with severe lumbar spondylolishesis.Methods 13 patients were fully decompressed by resecting the posterior bilaterial facet joints and the vertebral lamina, the reduction and fixation were made with SRS pedicle screws, thus decompression, reduction internal fixation and bone grafting fusion were finished within one operation; cages were applied to 10 patients and the other 3 patients received whole ilium grafting.Results After operation, all the 13 patients gained reduction and fusion without infection; except one case with temporarily stretching of the nerve roots, the others had no neurological deterioration; the symptoms were improved of certain degree: excellent in 9 patients, good in 3 patients and general in 1 patient; the follow-up lasting from 3 months to 42 months with the average of 13 months revealed stable condition and clear symptom improvement of the patients; the X-ray images showed good fusion of the grafting bones and no break-up of the screws; no other long-term complications were found.Conclusions Posterior operation of full decompression and complet reduction can save the patients with severe lumbar spondylishesis from the sufferings of the second operation and it is a new method in clinic. 　　Keywords lumbar spondylolishesis decompression spinal fusion 　　重度腰椎滑脱是指滑脱移位大于50%，按Meyerding分度在Ⅲ度以上(滑脱50