腰椎滑脱手术中复位困难的临床治疗研究

目的评价运用脊柱滑脱复位固定系统(SRS)加新型椎体复位系统治疗峡部不连性腰椎滑脱症的治疗效果。方法临床共治疗62例腰椎峡部不连性滑脱,按症状改善、骨性融合、内固定材料牢固情况进行疗效评价。结果62例获得1～5年随访(平均2年5个月),优47例,良12例,可3例,无症状加重患者。无内固定松动断裂发生。结论SRS系统治疗峡部不连性腰椎滑脱症,结合应用新型椎体复位系统能达到很好的复位及牢固的固定。手术操作简便,2次减压法效果满意。     

椎间融合器加提拉复位系统治疗腰椎滑脱症

目的探讨应用椎体提拉复位系统(spondylolisthesis reducation system,SRS)加单侧椎间融合器融合治疗峡部不连性腰椎滑脱症的疗效。方法自1998年2月至2005年6月治疗36例峡部不连性腰椎滑脱患者,手术对椎管和神经根管进行减压,用SRS对椎体进行复位内固定,后方斜向单个椎间融合器植入椎间融合,并在峡部植骨。按椎体复位、JOA评分、融合及内固定稳定程度和椎间隙高度变化等进行疗效评价。结果36例患者获6个月~7年的随访,手术完全复位35例,JOA评分平均26.8分,椎体全部融合,无内固定松动,椎间高度变化平均为1.7 mm。结论SRS加单侧椎间融合器是治疗峡部不连性腰椎滑脱症的有效方法。     

椎间植骨融合加SRS 系统治疗腰椎滑脱症

目的 探讨运用Spondylolisthesis Reduction System(SRS)提拉复位系统加环锯取髂骨于椎体间行单侧或双侧植骨融合治疗峡部不连性腰椎滑脱症。方法 临床共治疗43例腰椎峡部不连性滑脱病人，按手术复位，症状改善，骨性融合，内固定材料牢固情况进行疗效评价。结果 43例患者获得1～5年(平均3年2个月)随访，按我们自拟疗效标准，优33例，良7例，可3例，无症状加重病例。完全复位38例。无内固定松动断裂发生。结论 环锯椎间植骨融合加SRS系统，能达到很好的复位及牢固的固定，从而达到椎间的骨性融合。手术操作简便，效果满意，如能采取双侧椎间同时植骨，增加融合面积，效果更佳。     

短节段内固定系统加椎间植骨融合治疗腰椎滑脱症

腰椎滑脱症是腰腿痛常见原因之一，治疗方法很多，目前公认的治疗方法是滑脱椎体的复位，马尾神经及神经根的减压，固定和融合不稳定的节段。2004-2005年我们应用短节段内固定系统（SRS系统）加椎间植骨融合治疗峡部不连性腰椎滑脱症20例，疗效满意，报告如下。     

椎弓根螺钉联合椎间植骨融合器治疗腰椎滑脱症的远期疗效分析

[目的]探讨椎弓根螺钉系统联合椎间植骨融合器治疗峡部不连性腰椎滑脱症的远期疗效。[方法]自1996年10月~2002年10月本组收治峡部不连性腰椎滑脱症105例,随访资料齐全者86例。所有患者均行椎弓根螺钉系统复位滑脱,椎间植骨融合器行椎间融合固定。62例患者中1枚融合器从后斜向前呈45°植入,24例为2枚融合器从后向前垂直植入。随访测定固定节段的椎体间有无移位、滑脱有无复发,比较术前、术后2周及随访时固定椎间隙高度与近端第2椎间隙高度比值的变化。[结果]随访2~8年,平均35个月。根据NaKai评分标准,本组优56例,良13例,可17例,优良率为80.23%。Ⅰ度腰椎滑脱19例术后全部解剖复位;Ⅱ度腰椎滑脱51例中5例遗留Ⅰ度滑脱;Ⅲ度腰椎滑脱16例中4例留有Ⅰ度滑脱。末次随访时使用1枚融合器或2枚融合器所固定的椎间隙高度与近端第2椎间隙高度的比值与术后2周时的比值相比有所减低,滑脱无复发。[结论]椎弓根螺钉加椎间植骨融合器治疗腰椎滑脱症手术疗效满意,显著提高融合率,预防神经根管狭窄、神经卡压的发生,减少术后断钉和滑脱复发等问题。     

椎间植骨融合器联合椎弓根钉内固定系统治疗腰椎滑脱症

目的探讨椎间植骨融合器（cage）联合椎弓根钉系统内固定治疗腰椎滑脱症的疗效。方法回顾、总结2004年3月～2008年6月收治峡部不连性腰椎滑脱症31例,行椎弓根钉内固定系统作滑脱复位后加单侧cage椎间融合固定。随访观察固定节段有无位移,滑脱有无复发。结果随访24～72个月、平均36个月,椎间高度维持良好,固定节段无移位,滑脱无复发。结论椎间植骨融合器（cage）联合椎弓根钉系统内固定治疗腰椎滑脱症可减少术后断钉和复发的问题,是治疗腰椎滑脱症比较理想的手术方式。单侧cage即可以达到稳定椎间的作用。     

腰椎滑脱症手术复位与未复位的对比

[目的]探讨腰椎滑脱症经手术减压、神经根松解后,对滑脱椎体行复位与未复位进行对比,为指导临床对该症的手术治疗提供参考。[方法]患腰椎滑脱症经手术减压,神经根松解、行Steffee或M8腰椎内固定手术治疗的病人61例,术中对滑脱椎复位或未复位。[结果]术后随诊平均37.8个月,参照Yuan评价标准。复位组与未复位组无显著性差异。[结论]对轻度(<50%)腰椎滑脱病人,术中对滑脱椎节段椎管、神经根管彻底减压,神经根松解,椎弓根内固定后,对滑脱椎体进行复位与不复位无显著性差异。轻度腰椎滑脱症,可以选择不复位。     

改良椎间植骨融合联合椎弓根钉内固定治疗峡部裂性腰椎滑脱症

目的探讨运用滑脱椎"漂浮椎板"修整后椎间植骨联合椎弓根钉系统复位内固定治疗峡部裂性腰椎滑脱症的疗效。方法采用滑脱椎"漂浮椎板"修整后椎间植骨联合椎弓根钉系统复位内固定治疗峡部裂性腰椎滑脱症21例,评价术后椎间植骨愈合、滑脱复位及椎间高度恢复情况。结果随访6～28个月,患者均获得骨性融合。疗效评价按侯树勋等评定标准:优16例,良3例,可2例。结论运用滑脱椎"漂浮椎板"修整后椎间植骨联合椎弓根钉系统复位内固定治疗峡部裂性腰椎滑脱症具有手术操作简单、复位满意、植骨融合率高等优点。     

椎弓根螺钉加椎间植骨融合器治疗腰椎滑脱症的远期疗效分析

目的:探讨椎弓根螺钉系统加椎间植骨融合器(cage)治疗峡部不连性腰椎滑脱症的远期疗效。方法:1996年10月～2002年1月收治的峡部不连性腰椎滑脱症患者中资料齐全的82例,均在椎弓根螺钉系统作滑脱复位后加cage行椎间融合固定。58例为1枚cage从后斜向前呈45°置入,24例为2枚cage从后向前垂直置入。随访时观察固定节段的椎体间有无位移、滑脱有否复发,测量术前、术后2周及随访时固定椎间隙的高度与近心端第二椎间隙高度比值的变化。结果:随访24～86个月,平均36个月。根据Nakai评分标准,优良率为79.3%。19例Ⅰ度腰椎滑脱患者术后全部解剖复位;47例Ⅱ度滑脱患者5例留有Ⅰ度滑脱;16例Ⅲ度滑脱患者4例留有Ⅰ度滑脱。至随访时,使用1枚cage或2枚cage所固定的椎间隙高度与近心端第二椎间隙高度的比值较术后2周时的比值减低,但统计学上无显著性差异,滑脱无复发。结论:使用椎弓根螺钉加cage治疗腰椎滑脱症可减少术后折钉和滑脱复发的问题,是治疗腰椎滑脱症比较理想的手术方式。1枚cage即可以达到稳定椎间的作用。     

椎弓根螺钉内固定结合椎体间植骨术治疗腰椎滑脱症的疗效观察

目的探讨应用后路椎板减压、椎弓根螺钉复位固定、椎体间植骨术治疗峡部裂性腰椎滑脱症的临床效果。方法对43例峡部裂性腰椎滑脱症行后路减压、椎弓根螺钉复位固定结合椎体间植骨术治疗。评价术后滑脱复位和椎间植骨愈合情况。结果随访6～24个月,平均14.6个月。术后6～12个月复查腰椎X线片,4例植骨区仍有透亮影,2例出现滑脱椎体复位丢失。结论椎弓根螺钉复位固定、后路腰椎椎体间植骨融合术治疗峡部裂性腰椎滑脱症疗效满意,植骨愈合率高。     

Postoperative spondylolisthesis

The conditions and clinical significance of postlaminectomy spondylolisthesis were investigated in eight cases of lumbar spondylolisthesis, including five with slips not present at the time of decompression and three with progression of previously observed degenerative slips. All were women with an average age of 62 years. The major instability occurred at the L4-L5 level in seven of the eight cases. Either bilateral facetectomy or transection of the pars interarticularis had been part of the laminectomy. The L4-L5 level seems predisposed to spondylolisthesis in women whose facets have been destabilized by either bilateral removal or pars transection. Extra effort should be made to preserve facet stability during decompression, or add fusion after excision of posterior elements of spondylolisthesis.     

Lumbar spondylolisthesis

Summary The paper gives a survey, based on literature reports and our own experiences in 59 cases. According to Kilian (1853) spondylolisthesis is defined as ventral slipping of a vertebral body together with the pedicles. In pseudospondylolisthesis (Junghanns) the whole vertebra slips ventrally.Elongation of the isthmus of the pedicle or a cleft in the interarticular portion are prerequisites for spondylolisthesis. A dysplastic origin during childhood and adolescence is assumed. The relation of males to females is 2 1.Evolution of spondylolisthesis occurs during childhood and adolescence. The slipping process is finished in adults. Most often the condition is encountered in the lumbar, in particular in the lumbosacral, region. A third to one half of patients with spondylolysis (5–7%) demonstrate spondylolisthesis.Spondylolisthesis is usually an accidental finding, although the condition may lead to low back pain and sciatica. The earlier symptoms arise the gloomier usually is the prognosis. Very rarely a herniated disc is the cause of symptoms. Sciatica is mostly due to irritation of a nerve root by compression on the vertebral edge. Low back pain is caused by arthrogenic, pseudoarthrotic, and spondylotic degenerative disease.Diagnosis is established by AP, lateral, and oblique X-rays, and functional investigations. Myelogram and ossovenogram demonstrate compression of caudal sac and nerve roots.Conservative treatment consists of drugs and physical therapy, and cures one fifth of the patients. The best operative results are found after decompression and stabilisation (Cloward).Dedicated to Prof. Dr. Dr. h. c. H. W. Pia on the occasion of his 60th anniversary.     

Low-grade spondylolisthesis

Spondylolisthesis is an often painful condition affecting millions of people in North America with some ethnic variability. It is characterized by the displacement, usually anterior, of on vertebral body upon another. There are familial predispositions to having the lesion, and a family history of spondylolisthesis may raise one's clinical suspicion. Although the diagnosis is easily made on radiographic evaluation, the pathoetiology and appropriate treatment modality are not always as clear. In the absence of severe neurological symptoms or an unsafe component of instability, a trial of conservative management is reasonable and prudent. Nevertheless, surgical management is more efficacious for enduring symptomatic relief and restoration of physical function. Whereas assessment of postoperative radiographic results lends insight to surgical technique, the true barometer of treatment success is improvement in patient quality of life.     

急性创伤性腰椎滑脱

目的 探讨急性创伤性腰椎滑脱(acute traumatic spondylolisthesis，ATS)的临床特点。方法 1999年5月～2002年1月诊治7例急性创伤性腰椎滑脱患：1例症状轻行保守治疗，其余6例滑脱均行切开复位内固定植骨术。结果 7例获1～11年，平均5年2个月随访。临床疗效按Henderson标准评价：优6例，良1例。结论 与峡部崩裂滑脱相比，ATS伴软组织损伤与峡部骨折或小关节突骨折，绝大多数需手术治疗。     

Preoperative reduction of spondylolisthesis

The treatment of SL, especially in some cases, is mostly surgical. This lesion can be considered an extremely localised kyphosis (only two vertebrae) or a localized (sub-)luxation: at most hearetically pre-operative reduction should represent the first stage of the treatment, also because reduction makes further surgery easier and enables us to obtain the best results. After a glance at the various surgical techniques that have been used in the past, we describe our method of preoperative reduction in case of severe SL, an improvement of Scaglietti's original technique. According to the parameters taken into consideration, spondylolisthesis (SL) of the 4th and, above all, the 5th lumber vertebrae can be considered, especially in severe cases, as kyphosis or displacement (or even dislocation in the case of ptosis). In SL-kyphosis the antero posterior axes of the contiguous vertebral bodies are no longer parallel but tend to over-impose one to the other anteriorly forming an open posterior angle of varying degrees. It is an extremely short kyphosis (only two vertebrae) but from all points of view, even therapeutic, it reflects the characteristics of all types of vertebral kyphosis. SL-subluxation or SL-luxation (ptosis) is characterized by the respectively partial or total loss of normal alignment between the vertebrae involved. This can be explained by the fact that nearly all those who have dealt with the problem of treating SL, especially of L5, always ask themselves beforehand if it is possible and/or opportune to eliminate or improve the condition before surgery. In other words the question of reduction (pre or intraoperative, partial or total) of more or less severe L5 SL is always considered by all authors, even if their conclusions are often in disagreement.