峡部裂型和退变型腰椎滑脱的融合方式选择.doc

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 （第三军医大学第三附属医院脊柱外科 400042 重庆市） 目的：比较后外侧植骨与椎体间植骨融合术在治疗不同类型腰椎滑脱症的疗效。 方法：在2003年1月1日至2010年1月1日期间，我科采用后路切开复位、减压、植骨融合内固定手术治疗133例腰椎滑脱症患者。按峡部裂型和退变型分为两组。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。术后平均随访18个月（12月～3年）。比较两组患者术后症状缓解情况，随访过程中观察比较植骨融合情况，并在最终随访时采用腰椎JOA评分评估患者临床效果，比较两种植骨融合方法对治疗效果的影响。 结果：所有患者术后症状均有明显缓解。但在峡部裂型滑脱患者中，有5例采用后外侧植骨融合方式的患者，术后12个月复查时可见滑脱复位丢失，再次出现腰痛症状。其中2例需翻修手术（改用椎体间融合）治疗，3例给予严格佩戴支具等保守治疗后获得骨性融合。退变型腰椎滑脱患者均获得了骨性融合，脊柱稳定性好，症状缓解明显。最终随访时，JOA评分较术前平均提高8～10分。 结论：峡部裂型腰椎滑脱症患者采用椎体间植骨融合能获得良好的脊柱稳定性，但采用后外侧植骨融合则有复位丢失、内固定失效的风险明显增加。退变型腰椎滑脱症患者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，治疗效果好。 关键词：腰椎滑脱，后路手术，后外侧融合，椎体间融合 The choice of fusion technique for isthmic spondylolisthesis and degenerative spondylolisthesis Tu Hongbo, Liu Feng, Liu Peng, Zhao Jianhua Spinal surgery, of Third Affiliated Hospital of Third Abstract Objective: Comparison of 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. 10 cases of isthmic spondylolisthesis were treated with posterolateral fusion technique, 42 cases of isthmic spondylolisthesis were treated with lumbar interbody fusion technique. 26 cases of degenerative spondylolisthesis were treated with posterolateral fusion technique, 55 cases of degenerative spondylolisthesis were treated with lumbar interbody fusion technique. The follow-up was from 12 months to 3 year( the average was 18 months). At the last follow-up, the clinical results and the bone fusion were compared between the two bone fusion techniques.