腰椎滑脱症翻修手术(附21例报告)

目的探讨腰椎滑脱症初次手术失败原因、翻修手术方式及疗效。方法回顾分析2003年4月～2006年10月21例腰椎滑脱症翻修手术病例,针对初次手术失败的原因,分别应用后路椎弓根螺钉复位内固定加椎体间植骨融合术、后路椎弓根螺钉复位内固定加前路椎体间植骨融合术以及后路椎弓根螺钉复位内固定加前路游离腓骨移植椎体间植骨融合术进行再次手术,比较术后疗效、滑脱椎体复位率以及植骨融合率。结果本组全部患者翻修手术后均获随访,时间为4～48个月,平均32.6个月,总体优良率为90.48%,所有翻修手术病例植骨融合良好,植骨融合最短时间为3.8个月,最长时间为6.4个月,滑脱椎体再次复位后矫正度无丢失,椎弓根螺钉无松动及断裂。结论腰椎滑脱症初次手术失败原因主要与手术方式选择不当、忽视植骨融合的质与量以及手术操作不当有关,只要翻修手术方式得当、术中仔细操作、合理应用内固定及植骨融合材料,仍能取得满意疗效。     

老年退行性椎体滑脱伴腰椎管狭窄症的手术治疗

目的 对老年退行性椎体滑脱伴腰椎管狭窄定的患者行椎管减速压、松解神经根,实施Tenor-Ⅱ内固定系统复位和固定、后路椎体间Cage融合或横突间植骨融合术,重建腰椎稳定性.方法 手术过程包括后路减压、椎弓根螺钉固定,用自体骨进行融合,部分病例使用椎间融合器.结果 术后随访12～27个月.14例椎体间Cage完全融合,28例横突间植骨者4例未融合,融合时间为4～10个月.结论 后路减压使用椎弓根螺钉系统和椎间融合器可使植骨早期融合,提高临床疗效.     

腰椎滑脱症外科治疗策略选择

目的探讨不同类型腰椎滑脱症及合并症的手术治疗方式、疗效及优缺点。方法2000年2月～2004年4月应用后路椎弓根螺钉复位内固定后，分别采用后外侧植骨融合术、后路椎体间植骨融合术及前路椎体问植骨融合术治疗不同类型腰椎滑脱症及合并症的患者78例，比较术后及随访时疗效、滑脱椎体复位率、椎间隙高度恢复率、植骨融合率以及复位丢失率。结果术后28例Ⅰ度滑脱及37例Ⅱ度腰椎滑脱患者获得解剖复位．9例Ⅱ度滑脱及4例Ⅲ度腰椎滑脱患者矫正至Ⅰ度滑脱。随访时总体优良率为89．72％，42例椎体间植骨患者植骨融合良好，滑脱椎体复位无丢失，椎间隙高度维持良好；36例后外侧植骨者有12例复位丢失，2例椎弓根螺钉松动，2枚椎弓根螺钉断裂：结论对小于Ⅱ度退变性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉复位固定加后外侧植骨融合术；对峡部裂性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉固定加椎体间植骨融合术；对Ⅱ度以上峡部裂性单纯腰椎滑脱者以及腰椎滑脱翻修者宜选用后路椎弓根钉固定加前路椎体间植骨融合术。     

后路减压椎弓根螺钉内固定复位联合椎间融合器植骨融合术治疗腰椎滑脱症的体会

目的探讨后路减压椎弓根螺钉内固定复位联合椎间融合器植骨融合术治疗腰椎滑脱症的效果。方法对42例腰椎滑脱症患者予以后路减压椎弓根螺钉内固定复位联合椎间融合器植骨融合术,对其临床资料进行回顾性分析。结果 42例患者术后切口均I期愈合,植骨于3～12个月内均获骨性融合。未发生Cage融合器移位或沉陷及椎弓根钉棒松动、移位、断裂、滑脱复发等并发症。术后3个月及术后12个月腰、腿痛VAS评分均优于术前,差异有统计学意义(P0.05)。术后12个月复查,I度及Ⅱ度滑脱均完全复位,1例Ⅲ度滑脱复位改善明显。末次随访依据邹德威评分标准评定疗效。本组优31例,良10例,可1例。优良率为97.62%。结论后路减压椎弓根螺钉内固定复位联合椎间融合器植骨融合术治疗腰椎滑脱症,内固定稳定可靠,复位准确,椎体间融合良好,效果理想。     

不同手术方式治疗腰椎滑脱症的比较

目的：比较采用不同内固定及植骨融合方式治疗腰椎滑脱症的手术疗效及适应证。方法：应用后路椎弓根螺钉复位内固定后．分别采用后外侧植骨融合术、后路椎体间植骨融合术及前路椎体间植骨融合术治疗不同类型及合并症的腰椎滑脱症患者67例，比较不同术式的手术时间与出血量、手术疗效与并发症、滑脱椎体复位率与复位丢失率以及椎间隙高度。结果：后路椎弓根钉固定加椎体间植骨融合术手术时间最长、出血量最多。手术总体优良率为88．71％，三种术式间无差异。所有椎体间植骨组植骨融合良好，椎间隙高度维持良好，滑脱椎体复位无丢失；12例后外侧植骨者平均复位丢失率为11．24％，2例椎弓根螺钉松动，2枚椎弓根螺钉断裂。结论：退变性腰椎滑脱者宜选用后路椎弓根钉固定加后外侧植骨融合术；峡部裂性腰椎滑脱者宜选用后路椎弓根钉固定加椎体间植骨融合术；腰椎滑脱翻修者宜选用后路椎弓根钉固定加前路椎体间植骨融合术     

退变性腰椎滑脱症的手术治疗

目的探讨采用后路腰椎椎管减压、钉棒内固定并椎间植骨融合术和后路腰椎减压并Dynesys系统内固定手术治疗退变性腰椎滑脱的效果。方法应用后路腰椎椎间融合（posterior lumbar interbody fusion,PLIF）术进行椎管减压、钉棒系统固定并椎体间植骨融合手术治疗退变性腰椎滑脱37例;应用后路腰椎管减压并Dynesys内固定手术治疗退变性腰椎滑脱5例。结果随访9～39个月,平均26个月,腰痛疼痛视觉模拟量表（visual analogue scale,VAS）评分术前为8.7分,随访时为2.1分;腿痛VAS评分术前为7.6分,随访时为2.3分。术前Oswestry功能障碍指数（Oswestry disability index,ODI）为58.2%,随访时为21.2%。无严重手术并发症发生。术后X线片复查显示椎间高度均得到不同程度的恢复,滑脱椎体完全复位或者基本复位,椎间植骨融合。无融合器移位或螺钉松动、断裂。结论后路腰椎椎管减压、钉棒内固定并椎间植骨融合术和后路腰椎减压并Dynesys内固定手术治疗退变性腰椎滑脱效果满意,安全彻底的神经根管减压是取得满意临床效果的关键。     

腰椎滑脱后路不同融合术式的有限元研究

目的 建立L4.5，滑脱节段的有限元模型，研究椎弓根螺钉内固定加后外侧植骨融合、椎弓根螺钉内固定加双枚椎间融合器（cage）植入及椎弓根螺钉内固定加单枚融合器植入等3种融合术式的固定节段的稳定性。方法 选择一名56岁退变性腰椎滑脱女性患者，以k节段为研究对象，采用螺旋CT对其进行层厚1．0mm的连续水平扫描，将所得图像进行轮廓提取和阈值分割后，借助Ansys9．0软件，建立L4.5滑脱节段三维非线性有限元模型。同时根据椎弓根螺钉、融合器的几何尺寸，分别建立其相应的有限元模型。在此基础上，根据临床术式将上述模型进行不同组合，分别建立椎弓根螺钉固定加后外侧植骨融合、椎弓根螺钉固定加双枚融合器植入及椎弓根螺钉固定加单枚融合器植入等3种腰椎滑脱后路融合术式的有限元模型，然后分别施加压缩、前屈、后伸、侧屈及旋转等各种生理载荷，观察各模型不同载荷下螺钉、融合器的应力分布及融合节段的角位移变化，由此比较各模型的稳定性。结果 后外侧植骨融合术式的螺钉应力和角位移明显高于椎体间融合术（P〈0．01）；椎弓根螺钉内固定加单枚融合器植入与椎弓根螺钉内固定加双枚融合器植入两组之间螺钉应力、融合器应力及固定椎体的角位移的差异无统计学意义（P〉0．05）；各模型固定节段螺钉及融合器的最大有效应力均出现于前屈时。结论 椎弓根螺钉内固定加单枚或双枚融合器植入的稳定性优于椎弓根螺钉内固定加后外侧植骨融合；对于椎体间融合，植入单枚融合器和双枚融合器的稳定性无明显差别。     

退行性腰椎不稳的手术治疗

目的：探讨后路腰椎管减压、钉棒系统复位内固定、椎间融合器或横突间植骨融合治疗腰椎滑脱症的疗效.方法：对35例腰椎滑脱ugh患者进行腰椎管减压、钉棒系统复位内固定、椎间融合和横突间植骨的手术治疗.其中Ⅰ度滑脱32例,Ⅱ度滑脱3例.28例采用椎板开窗减压钉棒系统固定、横突间植骨融合术;7例采用全椎板减压钉棒系统固定、椎间融合器加植骨融合术.结果：35例中,30例术后2周内神经受压症状消失,X片显示内固定器械位置良好.5例术后出现神经症状加重：神经根刺激症状加重者4例,其中3例经治疗症状于3个月内缓解,1例症状未缓解者于术后8个月将内固定钉棒取出后症状缓解;不全瘫者1例,经二次手术探查后症状减轻.29例获得连续随访,随访时间2～3.5年,1例于术后6个月发现滑脱椎体再次轻度滑脱.1例因跌倒致椎弓根螺钉位置改变,伴有神经根刺激症状,将椎弓根螺钉取出后症状缓解,其余27例椎体滑脱完全复位,椎间融合或横突间植骨融合良好.临床疗效按照邹德威的综合评价标准评估：优20例,良7例,一般2例,优良率为93.1%.结论：后路腰椎管减压、钉棒系统复位内固定、椎间融合或横突间植骨治疗腰椎滑脱症效果满意.     

椎间植骨融合加椎弓根螺钉内固定治疗腰椎滑脱

目的探讨椎间植骨融合联合椎弓根螺钉内固定治疗腰椎滑脱症的效果。方法114例腰椎滑脱患者采用后路椎弓根螺钉复位固定加椎间植骨融合术。结果平均手术时间(267±23)min,出血量(915±175)ml,术中无神经、输尿管及大血管损伤等严重并发症。平均随访17.9(9~48)个月。椎间植骨融合率95.6%,融合时间平均9.3(3.5~6.5)个月,未融合5例。椎间隙高度维持良好,滑脱椎体复位无丢失。疗效评价:优73例,良29例,可9例,差3例,优良率为89.5%。结论椎间植骨融合加椎弓根螺钉内固定是治疗腰椎滑脱症的一种有效措施。     

GSS加椎间融合器治疗腰椎滑脱的临床分析

目的探讨后路应用通用型脊柱内固定系统（GSS）和椎体融合器（PEEK）经椎体间植骨融合术（PLIF）治疗腰椎滑脱的临床效果。方法对25例腰椎滑脱患者采用后路全椎板减压，GSS经椎弓根内固定并对滑脱椎体行复位固定，椎间融合器椎间植骨融合。结果随访12～36个月，临床优良率92.0%。12个月复查X线片均显示椎体间骨性融合。结论GSS椎弓根螺钉系统能有效撑开提拉滑脱椎体，复位满意，固定力强，并为彻底减压提供有效空间。采用椎间融合器植骨融合能有效提高植骨融合率。     

下腰椎手术失败原因分析及再手术治疗

目的：探讨下腰椎手术失败的主要原因及再手术的可能性。方法：42例因各种下腰椎退行性变疾患手术治疗后失败的患者，包括椎间盘突出症15例，单节段退变性神经根管狭窄症16例，腰椎滑脱症9例，多节段退行性神经根管狭窄症2例，其中34例为1次手术失败，5例为2次手术失败，2例为3次手术失败，1例为5次手术失败，经术前仔细影像学及临床周密检查，均再次手术，主要采用根管减压、侧后方腰椎间植骨融合内固定术。结果：手术失败原因可归结为定性定位错误、解剖不清、螺钉误置以及单纯依靠内固定而忽视融合等。经再次手术治疗后临床疗效优29例，良10例，可2例，1例根性瘫痪。42例患者下腰椎均重获正常解剖序列，滑脱患者全部获得满意解剖复位，随访半年以上均获得椎间融合。结论：下腰椎手术失败后，应认真分析原因，有针对性地再次行手术治疗，可使患者获得满意疗效。     

多裂肌间隙入路手术治疗腰椎手术失败综合征

目的探讨利用自行研制的一套腰椎微创手术器械,以多裂肌肌间隙入路直视下微创经椎间孔腰椎椎体融合术在腰椎翻修手术中的临床疗效。方法选择我院2010年11月至2011年11月收治的腰椎手术失败综合征行直视下微创腰椎翻修手术的患者12例进行回顾性分析,其中腰椎间盘突出症行单纯性椎板开窗减压髓核摘除术后6例,腰椎间盘突出伴腰椎不稳、腰椎滑脱行后路腰椎椎体融合术后4例,腰椎管狭窄后路椎板开窗减压术后2例;术前已进行一次手术的9例,二次手术的2例,三次手术的1例。本组共融合17节段,L4～54例,L5S13例,L4～5和L5S1双节段2例,L3～4和L4～5双节段3例;通过影像学资料和末次随访的临床表现进行改良Macnab标准疗效评定。结果所有病例均获得随访,随访时间6～18个月,平均(13±3.9)个月;依据改良Macnab标准进行疗效评定,12例中,优9例,良3例,可0例,差0例,优良率100%(12/12)。结论多裂肌肌间隙入路治疗腰椎手术失败综合征,降低了手术风险,减少了术后并发症。     

Degenerative spondylolisthesis: lumbar stenosis and instability.

Degenerative spondylolisthesis may manifest itself with different clinical pictures depending on the phase of the spondylotic disease. Based on pathophysiological criteria 24 patients affected with degenerative spondylolisthesis were divided into three groups: group I: those with spondylotic instability; group II: those with lumbar stenosis and current or potential segmental instability; group III: those with lumbar stenosis and naturally stabilized spondylolisthesis. Group I was treated by posterolateral fusion; group II by laminectomy, removal of the medial portion of the facets and posterolateral fusion; group III by laminectomy and removal of the medial portion of the facets. Long-term results were positive in 100% of the cases in group I, 90% in group II and 83% in group III, with no statistically significant differences between groups, because of the limited series of cases. The authors conclude that surgery for the treatment of degenerative spondylolisthesis must be based on age, symptoms, and the phase of the disease, and that when these indications suited to the clinical-radiographic picture are taken into account, good results may be obtained with different operations.     

经椎间孔入路腰椎间融合术（TLIF）治疗腰椎术后综合征疗效分析

目的探讨采用经椎间孔入路腰椎间融合术（TLIF）治疗腰椎术后综合征的临床疗效。方法对于26例腰椎术后综合征患者采取TLIF术治疗,术前行腰椎动态位摄片及腰椎MRI检查,所有病例均有病变间隙狭窄,6例存在腰椎不稳,18例有原间隙的椎间盘突出。结果所有患者均顺利完成手术,术中无神经根损伤,术后无脑脊液渗漏、切口感染等并发症,手术切口一期愈合。X线检查椎体间融合率100%。结论 TILF治疗腰椎术后综合症安全有效,是治疗该类疾病的标准术式。     

Early results of spinal fusion using variable spine plating system

Seventy-seven consecutive patients underwent application of variable spine plating (VSP) spinal plates between August 1984 and October 1985. Sixty-four percent had previous procedures at the same level or levels operated. Operative indications were spinal stenosis, segmental instability, unstable spondylolisthesis, herniated disc with instability, pseudoarthrosis, unstable fracture, and failed surgery syndrome with evidence of one of the preceding. Overall results showed 30% excellent, 30% good, 34% fair, 6% poor. There were four deep wound infections and 19 patients with one or more broken screws. Screw alignment and the angular relationship of each screw to the spinal plate are considered important technical factors in minimizing screw failure. Vigorous distraction of the vertebrae using interpedicular screws is rarely indicated. Twenty-four patients required reoperation. We feel the procedure is relatively indicated in cases of moderate to severe instability, such as some cases of spondylolisthesis, failed surgery with marked segmental instability, the obese, deconditioned patient, or cases of spinal stenosis rendered very unstable by surgical decompression, and most strongly indicated in unstable lumbar and thoracolumbar fractures.     

SOCON内固定器在治疗腰椎退行性滑脱中的应用

目的 观察腰椎管减压、横空间植骨和ＳＯＣＯＮ内固定手术治疗不稳定型退行性腰椎滑肿合并腰椎管狭窄患者的早期临床疗效。方法 从１９９７年１２月～１９９９年１月,２１例腰椎退行性滑脱合并腰椎管狭窄的患者,经长期（６～１２个月）严格保守治疗失败后,入院接受腰椎管减压、横空间植骨和ＳＯＣＯＮ内固定手术。２１例中表现为下腰痛、间歇性跛行者１９例,下肢疼痛者８例。经术前Ｘ线检查证实ＭｅｙｅｒｄｉｎｇⅠ度滑脱１８     

Lumbar fusion outcomes stratified by specific diagnostic indication

BACKGROUND: One of the primary difficulties in evaluating the effectiveness of lumbar fusion is that, with the exception of spondylolisthesis, specific diagnostic indications for surgery are poorly defined. Diagnostic specificity beyond the symptom of low back pain or the presence of lumbar degeneration needs to be delineated such that outcomes data can be effectively translated into clinical decision making or evidence-based guidelines. PURPOSE: The purpose of this study was to report on prospectively collected clinical outcome measures, stratified by diagnosis, among a series of patients with lumbar degenerative disease whose treatment included lumbar spine fusion. STUDY DESIGN: Demographics, diagnostic categorization, and clinical outcome measures were prospectively collected by six spine surgeons at a single tertiary spine center, as part of the surgeons' standard clinical practice. PATIENT SAMPLE: Four hundred and twenty-eight patients were enrolled in the study and complete 1- and 2-year Health-Related Quality of Life (HRQOL) data were available in 327 patients whose treatment included decompression and posterolateral lumbar fusion. OUTCOME MEASURES: The Oswestry Disability Index (ODI), Short Form-36 (SF-36), numeric rating scales for back pain and leg pain. METHODS: Preoperative diagnosis was classified, in the primary surgical cases, as disc pathology, spondylolisthesis, instability, stenosis, or scoliosis. In revision cases, the diagnosis was classified as nonunion, adjacent level degeneration, or postdiscectomy revision. Patient-reported outcomes at 1 and 2 years post-op were assessed based on diagnostic stratification. Statistical evaluation of clinical outcome was performed for both mean net change in outcome scores and the percentage of patients reaching a minimum clinically important difference (MCID) threshold for each outcome measure. RESULTS: Preoperative diagnosis was spondylolisthesis (n=80), scoliosis (n=17), disc pathology (n=33), instability (n=21), stenosis (n=46), postdiscectomy revision (n=67), adjacent level degeneration (n=40), or nonunion (n=23). Evaluation of 2-year post-op HRQOL measures by diagnostic subgroup revealed the most substantial improvement in ODI score for patients with spondylolisthesis (22.7 points) and scoliosis (21.2 points). Patients with the diagnosis of disc pathology (16.2 points), postdiscectomy revision (14.0 points), instability (12.7 points), stenosis (10.6 points), and adjacent level degeneration (9.5 points) demonstrated a progressively smaller magnitude of ODI improvement. The least ODI improvement at 2 years after surgery was seen in patients with nonunion of a prior fusion (5.5 points). The percentage of patients reaching MCID for ODI at 2 years post-op ranged from 71.0% in the spondylolisthesis subgroup to 34.8% in the nonunion subgroup. The greatest SF-36 physical component score improvement at 2-year follow-up was seen in patients with disc pathology (7.9 points) and spondylolisthesis (7.7 points), followed by scoliosis (6.6 points) and stenosis (6.5 points), instability (5.6 points), postdiscectomy revision (5.3 points) nonunion (3.1 points) and adjacent level degeneration (2.5 points). No significant changes from Year 1 to Year 2 were noted in any of the subgroups. For SF-36 physical component score, percentage of patients reaching MCID ranged from 63.6% in the disc pathology subgroup to 25% in the nonunion subgroup. CONCLUSIONS: This study supports the concept that added diagnostic specificity is a critical component in building an improved evidence base for lumbar fusion surgery. The magnitude of HRQOL improvement was not equal among diagnostic subgroups. The percentage of patients reaching an MCID level of improvement was also significantly influenced by diagnostic stratification. Without diagnostic specificity for entities beyond spondylolisthesis, the absence of well-defined study populations will continue to limit our ability to move toward evidence-based decision making.     

腰椎滑脱的减压、内固定与融合术

目的观察采用腰椎管减压、横突间植骨、Cage椎间融合器和SOCON内固定治疗腰椎滑脱合并腰椎管狭窄的早期疗效。方法从1997年12月～1999年12月,对38例腰椎滑脱患者采用腰椎管减压,横突间植骨和SOCON内固定手术进行治疗。术前X线检查按Meyerding分度,Ⅰ度滑脱32例,Ⅱ度滑脱6例;L4,5滑脱29例,L5S1滑脱9例。结果术后平均随访18.2个月(14～26个月),比较手术前后临床症状和X线片滑脱复位程度,38例患者中,31例症状完全消失,优良率为81.6%。32例Ⅰ度滑脱完全复位,4例Ⅱ度滑脱完全复位,2例Ⅱ度滑脱复位达90%,解剖复位率达94.7%。结论应用SOCON内固定治疗腰椎滑脱,效果良好,复位满意。     

体重指数对微创手术治疗单节段腰椎管狭窄症并腰椎不稳疗效的影响

目的:探讨体重指数(BMI)对微创减压经椎间孔腰椎间融合术联合经皮椎弓根螺钉内固定术治疗单节段腰椎管狭窄症并腰椎不稳的疗效的影响。方法:对2010年3月~2011年3月57例微创通道下行减压经椎间孔腰椎椎间融合术联合经皮椎弓根螺钉内固定手术治疗的单节段腰椎管狭窄症并腰椎不稳患者进行回顾性分析,按患者BMI不同分为3组,A组:正常体重组(BMI<25kg/m2),男14例,女17例;B组:超重组(25kg/m2≤BMI<30kg/m2),男7例,女12例;C组:肥胖组(BMI≥30kg/m2),男3例,女4例。记录每组患者手术时间、术中出血量、术后住院时间、手术并发症情况;术前、术后6个月及末次随访时行JOA评分(29分法)、Oswestry功能障碍指数(ODI)评定;末次随访时根据Bridwell椎间融合标准评价各组融合情况。年龄、性别构成比、术前JOA评分与ODI及随访时间3组之间无统计学差异(P>0.05),比较3组疗效。结果:3组患者手术时间有统计学差异(P<0.05),术中出血量及术后住院时间无统计学差异(P>0.05)。A组及C组各有1例术中硬膜囊撕裂;B组1例骨质疏松患者行椎间融合时融合器打入上位椎体中,术中取出融合器,予椎体间自体骨植骨融合;术后4例(A组1例,B组1例,C组2例)患者出现切口愈合不良,经抗生素及换药等治疗术后15~18d切口愈合。随访8～20个月,3组患者术后6个月及末次随访时JOA评分及ODI均较术前明显改善(P<0.05),术后6个月及末次随访时JOA评分及ODI 3组之间均无统计学差异(P>0.05);末次随访时,根据JOA评分计算临床改善率并评估手术疗效,其中A组优25例,良5例,可1例;B组优12例,良7例;C组优4例,良3例;3组优良率无统计学差异(P>0.05)。末次随访时,A、B及C组融合率分别为93.5%、94.7%和100%,3组之间无统计学差异(P>0.05);无融合器沉降、移位或塌陷,无螺钉断裂及松动。结论:微创减压经椎间孔腰椎椎间融合术联合经皮椎弓根螺钉内固定手术是治疗单节段腰椎管狭窄症并腰椎不稳的一种较好手术方法,BMI对其疗效无明显影响。     

单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症

目的：探讨经椎间孔入路单侧椎弓根钉固定结合单枚融合器治疗腰椎不稳症的临床疗效。方法：回顾性分析2009年至2012年收治且获得8个月以上随访腰椎不稳症50例,均有顽固性或反复下腰痛,有单侧或单侧为主的下肢放射痛,X线片及CT片显示腰椎不稳。采用经椎间孔入路单枚融合器椎间融合,结合单侧或双侧椎弓根钉固定治疗。根据固定方法不同,分为单侧固定组和双侧固定组。单侧固定组20例22间隙,男8例,女12例;年龄26-66岁;峡部裂性Ⅰ度滑脱2例,退行性滑脱8例,腰椎间盘突出症10例;融合部位L3,41例,L4,512例,L5S19例。双侧固定组30例30间隙,男14例,女16例;年龄41-62岁;峡部裂型Ⅰ度滑脱4例,退行性滑脱14例,腰椎间盘突出症12例;融合部位L3,43例,L4,515例,L5S112例。分析两组患者的手术时间、术中出血量、术后引流量、并发症情况,并对其椎间隙高度、前凸角的变化、融合率及临床疗效等进行比较。结果：两组患者术后切口均Ⅰ期愈合,腰痛基本消失,下肢放射痛均消失,无感染、硬脊膜损伤等发生。单侧固定组术后无医源性神经症状,双侧固定组术后1例足下垂。所有患者获得随访,时间8-18个月,平均（10.8±4.3）个月。临床疗效按照JOA评分好转率（RIS）评定,两组均获得较好临床疗效,且两组融合率比较差异无统计学意义,两种内固定治疗方法均能有效增加病变椎间隙高度。单侧固定组较双侧固定组手术时间更短,术中出血和术后引流量更少。结论：只要严格掌握手术适应证,注意手术操作技巧,经椎间孔入路单枚融合器加单侧椎弓根钉治疗腰椎不稳症具有创伤小、出血少、恢复快、经济实用等优点。