峡部裂型和退变型腰椎滑脱的融合方式选择单中心7年经验的回顾性研究.docVIP

峡部裂型和退变型腰椎滑脱的融合方式选择：单中心7年经验的回顾性研究 涂洪波，柳 峰，刘 鹏，赵建华 （400042 重庆，第三军医大学大坪医院野战外科研究所脊柱外科） [摘要]目的 比较后外侧植骨与椎体间植骨融合术治疗不同类型腰椎滑脱症的效果。方法 2003-2010年我科采用后路切开复位、减压、植骨融合内固定手术治疗腰椎滑脱症患者133例。按峡部裂型和退变型分为2组。峡部裂型腰椎滑脱患者采用后外侧植骨融合术10例，采用椎体间植骨融合术42例；退变性腰椎滑脱患者采用后外侧植骨融合术26例，采用椎体间植骨融合术55例。术后应用JOA评分以及影像学检查对临床疗效进行评价。结果 平均随访18个月。末次随访时JOA评分为（25.7±1.2）分，与术前相比差异有统计学意义（P0.01）。滑脱复位率在峡部裂型滑脱患者为74.3%，术后1年融合率为90.4%。滑脱复位率在退变型滑脱患者为89.3%，术后1年融合率为98.4%。峡部裂型滑脱患者中，有5例采用后外侧植骨融合方式（该融合方式的50%）的患者，复查见滑脱复位丢失，其中2例翻修手术治疗，3例保守治疗后获得骨性融合。 结论 峡部裂型腰椎滑脱采用椎体间植骨融合融合率高，但采用后外侧植骨融合则有复位丢失、内固定失效的风险增加。退变型腰椎滑脱采用后外侧植骨融合与椎体间植骨融合均能获得良好的骨性融合。 [关键词] 腰椎滑脱；后路手术；后外侧融合；椎体间融合 [中图法分类号] [文献标志码] A The choice of fusion technique for isthmic spondylolisthesis and degenerative spondylolisthesis: a single-center, retrospective analysis of 7 years’ experiences Tu Hongbo, Liu Feng, Liu Peng, Zhao Jianhua (Department of Spinal Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China) [Abstract] Objective To compare clinical results of posterolateral fusion and posterior lumbar interbody fusion techniques in the treatment of lumbar spondylolisthesis. Methods Between January 1, 2003 and January 1, 2010, there were 133 cases of patients with lumbar spondylolisthesis treated in our department. All of the 133 cases of patients were treated with open reduction, decompression, bone graft fusion and internal fixation via the posterior approach. The patients were divided into two groups: isthmic spondylolisthesis and degenerative spondylolisthesis. Ten cases of isthmic spondylolisthesis were treated with posterolateral fusion technique, 42 cases of isthmic spondylolisthesis with lumbar interbody fusion technique. Twenty-six cases of degenerative spondylolisthesis were treated with posterolateral fusion technique, 55 cases of degenerative spondylolisthesis with lumbar interbody fusion technique. A score of JOA was used to assess clinical outcome. Results All cases wer