腰椎；椎体滑脱；手术方法、适应证；疗效____

腰椎滑脱症手术治疗的临床分析

http://www.100md.com 《中国矫形外科杂志》 2006年第11期

腰椎；椎体滑脱；手术方法、适应证；疗效,,腰椎；,椎体滑脱；,手术方法、适应证；,疗效,1资料与方法,2随访评估方法,3结果,4讨论,参考文献：

     摘要：[目的]通过对82例腰椎滑脱症手术治疗病人的回顾性临床分析，探讨有关腰椎滑脱症的手术适应证、术式选择及治疗效果。[方法]依据病人情况分别采取以下4种术式：A组，后路单纯植骨融合术18例，均Ⅰ度滑脱；B组，椎弓根钉固定复位椎板间植骨融合术31例，Ⅰ度11例，Ⅱ度20例；C组，减压、椎弓根钉固定复位横突间植骨融合术19例，Ⅰ度2例，Ⅱ度13例，Ⅲ度4例，包括椎间盘突出3例，椎管狭窄3例；D组，减压、椎间融合、椎弓根钉固定复位横突间植骨融合术14例，Ⅰ度1例，Ⅱ度10例，Ⅲ度3例，包括椎管狭窄6例(Ⅰ度1例、Ⅱ度4例、Ⅲ度1例)，椎间盘突出4例(Ⅱ度3例、Ⅲ度1例)。[结果]随访6个月~6 a 6个月，平均3 a 8个月，单纯植骨融合组(A组)18例中15例融合，其融合率83%、滑脱复位率003%，根据下腰痛的FRS评分标准，其改善率5269%。椎弓根钉固定复位椎板间植骨融合(B组)的31例中30例融合，其融合率96%，滑脱复位率83%，改善率5620%。减压、椎弓根钉固定复位横突间植骨融合组(C组)融合率89%、滑脱复位率90%、改善率5985%。减压、椎间融合、椎弓根钉固定复位横突间植骨融合组(D组)融合率100%、滑脱复位率92%、改善率6108%。[结论]不同的手术方式针对不同的手术适应证。手术方式的不同因病人的病情不同而不同。

    关键词：腰椎；椎体滑脱；手术方法、适应证；疗效

    Clinical study of different surgical procedures for the treatment of lumbar spondylolisthesis:clinical analysis on 82 cases∥QIN Zhiwei,SUN Lei,CHEN Xiaoliang,et alDepartment of Orthopaedics,the Central Hospital of Taian City,Taian Shandong 271000

    Abstract：[Objective]Through the analysis of 82 cases of spondylolisthesis treated with surgery,the different types of surgical procedures were evaluated[Method]Patients with spondylolisthesis were divided into 4 groups based on their pathology and different surgical procedures were used accordinglyGroup Ⅰ consisted of 18 patients with degenerative spondylolisthesis with back pain(3 cases)and isthmic spondylolisthesis(13 cases)and traumatic spondylolisthesis(2 cases)of Ⅰ degree;They were treated with posterior interlaminar and interspinous process fusion;Group Ⅱ consisted of 31 cases with degenerative spondylolisthesis(2 cases)and isthmic spondylolisthesis(23 patients)and traumatic spondylolisthesis(6 cases)of Ⅰ degree(11 cases)and Ⅱ degree(20 cases);They were treated with reduction of sliding vertebra and posterior interlaminar and interspinous process fusion;Group Ⅲ consisted of 19 cases with degenerative spondylolisthesis(2 cases)and isthmic spondylolistbesis(17 cases)of Ⅰ degree(2 cases),Ⅱ degree(13 cases)and Ⅲ degree(4 cases);They were treated with laminectomy and decompression,with reduction of sliding vertebra and transverse process fusion;Group Ⅳ consisted of 14 cases with isthmic spondylolisthesis of Ⅰ degree(1 case),Ⅱ degree(10 cases)and Ⅲ degree(3 cases);They were treated with laminectomy and decompression,with intervertebral body fusion,with reduction of sliding vertebra and transverse process fusion[Result]In group Ⅰ,solid fusion were in 15 cases giving a fusion rate of 83%,003% rate of reduction,5269% rate of improvement;In group Ⅱ,solid fusion were in 30 cases giving a fusion rate of 96%,5620% rate of improvement,83% rate of reduction;In group Ⅲ,fusion rate,reduction rate and improvement rate reached 89%,90%,5985% respectively;In group Ⅳ,the fusion rate,reduction rate and improvement rate were as high as 100%,92%,6108% respectively[Conclusion]Different operative methods have different operative indicationsOperative methods differ from different patients ......

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