Kho Victor Ka-siong, Chen Wein-Chih
Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2004 Nov;67(11):575-8.
This study was undertaken to assess the radiologic outcome of spinal fusion, with bone chips from laminectomy in patients with lumbar spondylolisthesis.
From January 1993 to September 2001, 95 patients with lumbar spondylolisthesis were managed and followed up well at our Orthopedic Division. All patients presented with persistent low back pain, radiculopathy and claudication. The diagnosis of lumbar spondylolisthesis was confirmed by plain radiographs of the lumbar spine, with lumbar spine computed tomography scan (CT-scan) performed to identify other associated conditions. A near total posterior decompression laminectomy with foraminotomy and posterolateral lumbar fusion using bone chips from laminectomy as bone graft and reduction of the vertebral slip using transpedicle screws with Arbeitsgemeinschaft für Osteosynthesefragen spinal fixators and Trifix Reduction Fixation spinal system implants, were instituted. Additional disectomies were performed in several patients with disc rupture as confirmed by CT-scan. Fusion was then assessed by plain lumbar radiographs done at 4, 8, and 24 months after operation.
The outcome was good, with 88 (92.6%) cases attaining solid fusion, while failed fusion was noted in 7 (7.4%) cases.
Proper decortication of the posterolateral vertebral gutter with removal of all soft tissues attached to the bone chips prior to the placement of bone graft were noted to be the most significant factors for spinal fusion. Fusion rate with bone chips from laminectomy was shown to be comparable to that of the iliac crest bone graft.
本研究旨在评估腰椎滑脱症患者行椎板切除术获取的骨块用于脊柱融合的放射学结果。
1993年1月至2001年9月，我院骨科对95例腰椎滑脱症患者进行了治疗及良好随访。所有患者均有持续性下腰痛、神经根病和间歇性跛行。腰椎正侧位X线片确诊腰椎滑脱症，并行腰椎计算机断层扫描（CT扫描）以确定其他相关情况。采用椎板切除术获取的骨块作为骨移植材料，行近乎全椎板减压、椎间孔切开及腰椎后外侧融合术，使用AO脊柱固定器和Trifix复位固定脊柱系统植入物经椎弓根螺钉复位椎体滑脱。对于CT扫描证实有椎间盘破裂的部分患者，还进行了椎间盘切除术。术后4个月、8个月和24个月行腰椎正侧位X线片评估融合情况。
结果良好，88例（92.6%）实现了牢固融合，7例（7.4%）融合失败。
注意在植骨前对椎弓根后外侧沟进行适当的骨皮质剥除，并去除附着在骨块上的所有软组织，是脊柱融合的最重要因素。结果显示，椎板切除术获取的骨块的融合率与髂嵴骨移植的融合率相当。
