椎弓根螺钉提拉复位与椎间隙撑开复位治疗峡部裂型腰椎滑脱症的临床效果观察

Clinical comparement of two surgical protocols between pedicle screw reduction and intervertebral space distraction reduction in treating isthmic spondylolisthesis

中文关键词:  腰椎滑脱症  复位  脊柱融合术

英文关键词:Lumbar spondylolisthesis  Reduction  Spinal fusion

中文摘要:

  【摘要】　目的：评价椎弓根螺钉提拉复位与椎间隙撑开复位治疗峡部裂型腰椎滑脱症的临床疗效。方法：68例峡部裂型腰椎滑脱症患者分别在两个医疗中心接受手术治疗。A组32例，L4滑脱5例，L5滑脱27例，术前滑移程度为35.8％±10.4％，JOA评分为17.2±1.6分，采用后路椎板减压，在滑脱椎体先置入提拉螺钉，通过螺钉间撑开、提拉复位后，椎间隙内填充自体碎骨粒后置入1枚椎间融合器。B组36例，L4滑脱6例，L5滑脱30例，术前滑移程度为36.1％±11.2％，JOA评分为17.9±1.4分，采用后路椎板减压，逐步撑开椎间隙、利用纤维环和周围韧带的张力部分复位后置入1枚椎间融合器，并在融合器内及其周围植入自体碎骨，再行椎弓根钉棒系统固定。比较两组患者临床疗效。结果：A组术中和术后并发症发生率为18.8%（6/32），B组为11.1%（4/36），两组比较无显著性差异（P>0.05）。随访24~60个月，平均39个月。A组末次随访时滑移程度为3.4％±1.9％，滑脱复位率为90.5%，2年融合率为96.9%；末次随访时JOA评分为26.5±0.9分，临床疗效满意率为87.5%。B组末次随访时滑移10.3％±4.1％，滑脱复位率为71.5%，2年融合率为97.2%；末次随访时JOA评分为26.9±1.1分，临床疗效满意率为86.1%。两组之间临床疗效满意率、融合率无显著性差异（P>0.05），但滑脱复位率有显著性差异（Ｐ<0.001）。结论：椎弓根螺钉提拉复位法的复位效果优于椎间隙撑开复位法，但两种复位方法均能有效治疗峡部裂型腰椎滑脱症。

英文摘要:

  【Abstract】 Objective：To investigate the clinical effects of two surgical protocols between pedicle screw reduction and intervertebral space distraction reduction in treating isthmic spondylolisthesis.Method：68 cases with isthmic spondylolisthesis undergoing surgical treatment at two separate centers were reviewed retrospectively.Group A，32 cases，there were 5 at L4 and 27 at L5.Average preoperative slippage and JOA score were 35.8％±10.4％ and 17.2±1.6 respectively.After posterior lamenectomy and insertion of pedicle screws into involved level，reduction was accomplished by distraction and pulling of the reduction screws，after that，the disc space was prepared，finally the placement of cage and sliced autograft was performed sequently.Group B，36 cases，there were 6 at L4 and 30 at L5.Average preoperative slippage and JOA score were 36.1％±11.2％ and 17.9±1.4 respectively.Posterior laminectomy and unilateral facetectomy on the symptomatic side followed by reduction through intervertebral disc space distraction was performed，then pedicle screw instrument and one single fusion with bone graft was applied.The clinical outcomes were compared between the two groups.Result：The complication rate was 18.8%（6/32） in group A and 11.1%（4/36） in group B，no significant difference was found between two groups（P>0.05）.The follow up time was 24-60 months（average，39 months）.In group A，the slippage degree was 3.4％±1.9％ at final follow-up with the reduction rate of 90.5%，fusion rate at two year follow-up of 96.9%，JOA score of 26.5±0.9 at final follow-up，clinical satisfaction rate of 87.5%.While in group B，the slippage degree was 10.3％±4.1％ at final follow-up with reduction rate of 71.5%，fusion rate at two year follow-up of 97.2%，the JOA score of 26.9±1.1 at final follow-up，clinical satisfaction rate of 86.1％.No significant difference was found in clinical satisfactory rate and fusion rate between two groups（P>0.05），however significant difference was noted in reduction rate between two groups（Ｐ<0.001）.Conclusion：The reduction rate by pedicle screw is superior to that by intervertebral disc space distraction，both two methods show efficacy in surgical treatment of lumbar spondylolisthesis.