Klöckner C, Weber U
Orthopädische Universitätsklinik, Freien Universität Berlin, Zentralklinik Emil von Behring, Stiftung Oskar Helene-Heim, Gimpelsteig 9, 14165 Berlin.
Orthopade. 2001 Dec;30(12):983-7. doi: 10.1007/s001320170012.
Spondyloptoses, but also high-grade spondylolistheses, usually only develop at the lumbosacral junction and are nearly always classed among dysplastic spondylolistheses. Kyphosis of the lumbosacral junction leads to compensation mechanisms with increased lumbar lordosis and straightening of the pelvic tilt with involvement of the hip and knee joints. Reconstructing a physiological sagittal profile by more or less complete repositioning with permanent fusion of only the lumbosacral motion segment is thus of primary importance in the surgical management of high-grade spondylolisthesis and spondyloptosis. This aim led to the following treatment modality: Dorsal repositioning following sacral dome resection with subsequent intersomatic fusion with the posterior lumbar interbody fusion (PLIF) technique. This procedure was performed in 11 patients between January 1995 and January 1998 for six grade IV spondylolistheses and five spondyloptoses. Four patients had undergone previous surgery. Measurements of the slip angle (Boxall), sagittal translation (Taillard), sacral inclination (Boxall), and sagittal rotation (Wiltse and Winter) were done in the follow-up and to check the postoperative results. Denis' pain scale was used to classify pre- and postoperative complaints as well as those of the last examination. Only one inadequate repositioning occurred in a previously operated patient who required instrumentation from L4 to S1 after a pedicle screw had been torn out at L5. In another previously operated patient, the dura was damaged intraoperatively and managed accordingly. Postoperatively, this patient developed a unilateral nerve root syndrome, which did not improve in the further course. Another patient developed decompensation of the adjacent cranial motion segment in the follow-up period. In ten cases complete or nearly complete reposition was achieved. Firm bone consolidation was seen in all patients. Complaints were markedly reduced in all patients compared to the preoperative status.
椎体滑脱，以及严重的腰椎滑脱，通常仅发生于腰骶关节，几乎总是归类于发育不良性腰椎滑脱。腰骶关节后凸会引发代偿机制，导致腰椎前凸增加以及骨盆倾斜变直，并累及髋关节和膝关节。因此，通过对腰骶运动节段进行或多或少的完全复位并永久融合来重建生理矢状面形态，在严重腰椎滑脱和椎体滑脱的手术治疗中至关重要。这一目标促成了以下治疗方式：在切除骶骨穹窿后进行后路复位，随后采用后路腰椎椎间融合术（PLIF）进行椎间融合。1995年1月至1998年1月期间，对11例患者实施了该手术，其中6例为IV度腰椎滑脱，5例为椎体滑脱。4例患者曾接受过手术。在随访过程中进行了滑脱角（Boxall法）、矢状面移位（Taillard法）、骶骨倾斜度（Boxall法）和矢状面旋转（Wiltse和Winter法）的测量，以检查术后结果。采用Denis疼痛量表对术前、术后以及最后一次检查时的疼痛情况进行分类。在1例曾接受手术的患者中，仅出现1次复位不充分的情况，该患者在L5椎弓根螺钉拔出后需要从L4至S1进行内固定。在另1例曾接受手术的患者中，术中硬脊膜受损并进行了相应处理。术后，该患者出现单侧神经根综合征，在后续病程中未改善。另1例患者在随访期间出现相邻上位运动节段失代偿。10例患者实现了完全或近乎完全复位。所有患者均可见牢固的骨融合。与术前相比，所有患者的疼痛症状均明显减轻。
