摘要
目的:通过对202例腰椎滑脱手术治疗病人的临床分析,探讨有关腰椎滑脱的手术适应证和术式选择问题。材料和方法:本组手术适应证和术式选择的标准为:(1)无症状或单纯腰痛但经保守治疗可消除疼痛者,无需手术;(2)对38例有腰痛症状的退变性滑脱和<33%的峡部裂性滑脱,采用前路椎间植骨融合;(3)对有单侧肢体放射痛的轻度峡部裂性滑脱,采用症状侧半椎板减压加对侧椎板及棘突间融合,共99例;(4)对65例滑脱>33%并伴有坐骨神经痛的病人,采用减压、滑脱椎体复位及椎间融合术。结果:随访前路椎间融合组22例中20例融合(融合率91%)。症状侧半椎板减压,对侧椎板及棘突间融合组随访59例,优良率91.5%,本法的缺点是固定节段过多,有条件时可采用单节段复位固定系统。减压、滑脱椎体复位及椎间融合组,49例随访1年以上,优良率91.8%,融合率95.9%。结论:腰椎滑脱复位的作用是增加融合面积,恢复脊柱的正常生物力学功能,解除对神经的牵拉和压迫,恢复正常矢状面曲线,改善外观和功能。对腰椎滑脱病人,手术的最基本目的是达到滑脱椎体与相应椎体的融合。应该避免单纯的椎板减压术。
Purpose: Through the analysis of 202 cases of spondylolisthesis treated with surgery, the different types of surgical procedures were reevaluated. Material and Method: Patients with spondylolisthesis were divided into 3 groups based upon their pathology and different surgical procedures were used accordingly. The results were evaluated after follow-up of more than one year. Group Ⅰ consisted of 38 patients with degenerative spondylolisthesis with back pain and isthmic spondylolisthesis of less than 33%; they were treated with anterior intervertebral body fusion. Group Ⅱ consisted of 99 cases of mild isthmic spondylolisthesis with unilateral sciatica, and were treated with semi-laminectomy and decompression of symptomatic side; interlaminar and interspinous process fusion of the opposite side was performed for 99 cases of mild isthmic spondylolisthesis with unilateral sciatica. Group Ⅲ consisted of 65 cases of spondylolisthesis more than 33% with sciatica and they were treated with decompression, reduction of sliding vertebra and posterior intervertebral body fusion. Result: In group Ⅰ, solid fusion was in 20 cases giving a fusion rate of 91%. In group Ⅱ, the satisfactory rate was as high as 91.5%. In group Ⅲ, the satisfactory rate and fusion rate reached 91.8% and 95.9% respectively. Conclusion: Reduction of spondylolisthesis could increase the fusion contact area, restore normal mechanics and saggital curve of the lumbar spine, relieve neural compression and improve the extemal appearance and function. For the surgical treatment of spondylolisthesis, the major goal should toward a solid fusion between the sliding vertebra and its adjacent vertebrae and laminectomy alone is not a procedure of choice.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
1998年第12期707-710,共4页
Chinese Journal of Orthopaedics
关键词
外科手术
手术适应症
腰椎滑脱
术式
Spondylolisthesis Lumbar vertebrae Surgery, operative
