摘要:
背景:参照目前最主流的后路椎弓根钉系统复位滑脱椎体并全椎板加压椎间Cage融合术,以往的手术焦点往往聚集在对滑脱椎体矢状位移的整复上,而对于椎间隙高度是否需要恢复及恢复到何种程度并无统一认识.有些文章对该论点或许有部分涉猎,但对于具体椎间隙恢复至多高较好的量化指标缺乏.目的:针对采用椎弓根钉固定全板减压椎间融合术式治疗的腰椎滑脱症患者,通过对比术中撑开椎间隙高度提拉复位与单纯提拉复位两种复位固定融合术的临床效果,观察椎间隙生理高度的恢复情况.方法:纳入60例L5椎体前滑脱症(L5/S1间隙滑脱)患者为研究对象,按照术中是否行撑开复位(恢复椎间隙高度)操作,分为撑开组与单纯提拉组,每组30例.其中撑开组行椎弓根钉系统提拉+撑开复位+后路减压椎间融合术治疗,采用12 mm高度椎间融合器融合;单纯提拉组行RF椎弓根钉系统单纯提拉复位+后路减压椎间融合术治疗,术中并不做椎间撑开处理,采用8 mm高度椎间融合器融合.分别记录2组患者一般资料及术前术后1个月及末次随访的目测类比评分、JOA评分、ODI,以及术后滑脱的矫正程度及骨融合情况,采用Macnab评分临床疗效.结果与结论:①术后1个月及末次随访提示,与单纯提拉组相比,撑开组在椎间隙高度、椎间隙高度/椎体高度比、椎间孔高度、椎间隙角度及临床疗效评分方面均占优势(P < 0.05);②结果表明,应用椎弓根钉固定加后路全椎板减压椎间融合术治疗腰椎滑脱症,术中尽可能恢复正常椎体间隙高度,有助于恢复更优的脊柱序列,对于改善患者症状具有一定优势,且术中操作不增加难度,可达到更好的术后效果,推荐临床首选.%BACKGROUND: According to the current most prevailed posterior pedicle screw reduction and Cage fusion for spondylolisthesis, the previous focus is to restore the vertebral sagittal displacement, and whether restoring disc height is needed and the degree of recovery remain unclear. Moreover, there is still a lack of better quantitative indicators to restore the disc height.OBEJCTIVE: By comparing the surgery of lifting reduction, to study the clinical effect of distraction and lifting reduction combined with posterior intervertebral fusion in the treatment of lumbar spondylolisthesis. METHODS: Sixty patients with L5 spondylolisthesis located in L5/S1 were selected, and were divided into two groups based on the surgery methods (n=30 per group): group A (single lifting reduction group) and group B (lifting and distracting reduction group). The patients in the group B were given distracting reduction amid insertion of 12 mm-height Cage; while the patients in the group A were subjected to lifting reduction, and intervertebral fusion with 8 mm-height Cage. The general information and the Visual Analogue Scale, Japanese Orthopaedic Association and Oswestry Disability Index scores at baseline, postoperative 1 month and last follow-up, as well as the postoperative correction and bone fusion were recorded. Additionally, the clinical effectiveness was assessed by Macnab score. RESULTS AND CONCLUSION: (1) At postoperative 1 month and last follow-up, the disc height, disc height/vertebral height, neuroforamen height and clinical effectiveness in the group B were superior to those in the group A (P < 0.05). (2) To conclude, the pedicle screw system combined with posterior intervertebral cage fusion for spondylolisthesis, can rapidly restore the disc height, contribute to restructure better biomechanics of spine. Furthermore, it significantly improves clinical systems, is easy to operate, and achieves better efficacy; therefore, it is recommended firstly.