腰椎滑脱RF复位椎体间嵌压植骨融合的疗效评定 (pdf)

    [摘要] 目的 探索腰椎滑脱后路减压治疗时，恢复脊柱稳定性的有效方法。方法 19例腰椎滑脱并峡部裂患者，男12例，女7例；年龄30～64岁，平均46.6岁。按Meyerding分类法，Ⅰ度8例，Ⅱ度11例；滑脱部位L4～5 6例，L5 S1 13例。均有明确神经根压迫症状，CT片示椎管或根管狭窄，经椎板切除减压RF复位固定后，利用RF的轴向撑开作用将环锯取下的圆柱状髂骨块嵌压于椎体间。术后定期复查，内固定取出后继续随访15～41个月，平均2年8个月。根据临床症状和X线片评定疗效。结果 植骨融合时间大多2～3个月，无不融合；内固定取出后无再滑脱现象；临床疗效按Macnab标准：优16例(84.2%)、良2例(10.5%)、可1例(5.3%)、差0例。结论 本手术具有复位固定作用可靠，术后卧床时间短，脊柱融合率高等优点。

    [关键词] 腰椎滑脱；脊柱融合；椎管减压

    Treatment for spondylolisthesis by posterior lumbar interbody fusion and RF pedicle screw fixation

    TAN Xiong-jin,LI Kang-hua,TANG Wei-fa,et al.Xiangya Hospital,Central South University,Changsha 410008,China

    [Abstract] Objective To demonstrate the efficacy of reduction and fixation by RF pedicle screw system and iliac dowel graft placement in the treatment of isthmic spondylolisthesis.Methods 12 male and 7 female patients,ranging in age from 30 to 64 years (average,46.6 years) were suffered from isthmic spondylolisthesis.According to Myerdingls grading,8 patients were classified as Degree Ⅰ lesion,11 as Degree Ⅱ lesion.All patients underwent a posterior decompressive laminectomy for symptomatic lumbar stenosis or narrowings of intervertebral foramens and lateral recesses demonstrated by computed tomography (CT).Then posterior reduction with pedicle screw instrumentation was followed by lumbar interbody fusion with pole bone.Follow-up period was continued from 1 year and 3 months to 3 years and 5 months with an average of 2 years and 8 months after internal fixation was removed.Clinical results were evaluated by means of clinical symptoms and radiographs for maintenance of reduction and fusion.Results All implanted bones were fused within 2 to 3 months.Clinical outcomes were measured with Oswestry questionnaire and Macnab evaluation scale.16 cases have obtained excellent results,2 cases good results,and 1 cases fair results.No cases with poor results were found.Conclusion This technique has been found to be a safe,rapid effective procedure for lumbar spondylolisthesis and it produced a high fusion rate.The patients need less time to lie in the bed. ......