原位融合与复位融合治疗轻度腰椎滑脱的疗效分析.docVIP

原位融合与复位融合治疗轻度腰椎滑脱的疗效分析 　　[摘要] 目的 采用原位融合、复位融合两种术式治疗成人轻度腰椎滑脱症，探讨两种手术方式的临床疗效。方法 2010年3月―2013年3月该院共进行121例成人轻度腰椎滑脱患者行手术治疗，A组35例（原位融合组），术中不进行复位，B组86例（复位融合组），术中行牵拉复位滑脱椎体。所有患者均行减压、椎弓根螺钉内固定、椎间或横突间植骨融合。根据手术患者术前、术后及末次随访时JOA功能评分以及术后2年融合率进行疗效评价。结果 121例患者术后均获得随访，随访时间12～48个月，平均36个月。术后与术前JOA评分差异有统计学意义（P0.05）。结论 严格掌握适应症，原位融合与复位融合对于治疗成人轻度腰椎滑脱均可获得满意疗效。 　　[关键词] 腰椎滑脱；原位融合；复位融合 　　[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2015）11（c）-0070-02 　　[Abstract] Objective To discuss the clinical effects of two operation methods of in-situ fusion and reset fusion in the treatment of adults with mild lumbar spondylolisthesis. Methods 121 cases of adults with mild lumbar spondylolisthesis treated from March 2010 to March 2013 were divided into group A （In-situ fusion group） with 35 cases in it and group B （Reset fusion group） with 86 cases in it ， both groups were given surgical treatment， group A were not reseted in operation， group B were given traction reduction of spondylolisthesis. All the patients were given decompression， pedicle screw fixation and intervertebral or intertransverse fusion. The effect was evaluated according to the JOA function score of preoperative， postoperative and final follow-up of patients and the fusion rate in 2 years after operation. Results 121 cases of patients were followed up after operation， and the followed-uptime ranged from 12 to 48 months with an average of 36 months.The difference in the JOA function score between preoperative and postoperative was statistically significant（P0.05）. Conclusion Both in-situ fusion and reset fusion treat adults with mild lumbar spondylolisthesis can obtain the satisfactory effect by strictly mastering indication. 　　[Key words] Lumbar spondylolisthesis； In-situ fusion； Reset fusion 　　腰椎滑脱由于关节突间连续性中断或延长引起椎体与椎弓根、横突和上关节突向前移位，是临床上引起腰背部疼痛的原因之一，其病程相对较长，发病机制复杂，治疗方式多样。关于术中是否对滑脱椎体进行复位，一直存在争议[1]。该研究通过分析2010年3月―2013年3月该院共进行的121例手术治疗轻度腰椎滑脱患者的临床资料，对术中是否复位进行探讨，现报道如下。 　　1 资料与方法 　　1.1 一般资料 　　成人轻度腰椎滑脱患者121例。I度滑脱76例，II度滑脱45例。男73例，女48例；年龄34～8