Fei Qi, Wang Yi-peng, Xu Hong-guang, Qiu Gui-xing, Weng Xi-sheng, Lin Jin, Tian Ye, Yu Bin, Xu Rui
Department of Orthopaedic Surgery, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2005 Apr 15;43(8):486-90.
To compare and evaluate instrumented posterior fusion with instrumented circumferential lumbar fusion in the treatment of lumbar stenosis with low degree lumbar spondylolisthesis.
From April 1998 to April 2003, 45 patients who suffered from lumbar stenosis with low degree lumbar spondylolisthesis were divided into 2 groups (A and B) at random. The patients in group A (n = 24, average age 54 years old) were performed decompressive laminectomy, intertransverse process arthrodesis with bone grafting and transpedicle instrumentation of solid connection (SOCON) system. The patients in group B (n = 21, average age 53 years old) were performed the same procedure as group A except adding posterior lumbar interbody fusion (PROSPACE). The main levels of lumbar spondylolisthesis in 2 groups was L(4 - 5) or L(5)-S(1). All cases were classified as degree 1 to degree 2. All patients in the two groups received preoperative myelography or CTM, and were diagnosed lateral recess stenosis and(or) central lumbar canal stenosis.
All the patients were followed up from 12 to 72 months. In group A, the results showed that the preoperative clinical symptoms disappeared completely in 12 of 24 patients, pain relief was seen in 91.7% (22/24), anatomical reduction rate was 91.7%. No infection or neurologic complication occurred in this series. In group B, the results showed that the preoperative clinical symptoms disappeared completely in 13 of 21 patients, pain relief was seen in 90.5% (19/21), anatomical reduction rate was 95.2%. Four cases of infection or neurologic complication occurred in this series. Two groups had no significant difference in follow-up clinical outcome and anatomical reduction rate. But group A had better intraoperative circumstances and postoperative outcome than group B, group B had better postoperative parameters in X-ray of angle of slipping and disc index than group A.
The best surgical treatment method of lumbar stenosis with low degree lumbar spondylolisthesis is complete intraoperative decompressive laminectomy, reduction with excellent transpedicle system instrumentation and solid fusion after bone grafting. The use of cage should be conformed to strict indications.
比较和评估后路器械融合术与腰椎环形器械融合术治疗轻度腰椎滑脱性腰椎管狭窄症的效果。
1998年4月至2003年4月，45例轻度腰椎滑脱性腰椎管狭窄症患者随机分为两组（A组和B组）。A组（n = 24，平均年龄54岁）患者行减压性椎板切除术、横突间植骨融合术及经椎弓根坚固连接（SOCON）系统内固定术。B组（n = 21，平均年龄53岁）患者除行与A组相同的手术外，还增加了后路腰椎椎间融合术（PROSPACE）。两组腰椎滑脱的主要节段均为L（4 - 5）或L（5）-S（1）。所有病例均为1度至2度。两组所有患者术前均行脊髓造影或CTM检查，诊断为侧隐窝狭窄和（或）中央椎管狭窄。
所有患者随访12至72个月。A组结果显示，24例患者中12例术前临床症状完全消失，91.7%（22/24）疼痛缓解，解剖复位率为91.7%。该组未发生感染或神经并发症。B组结果显示，21例患者中13例术前临床症状完全消失，90.5%（19/21）疼痛缓解，解剖复位率为95.2%。该组发生4例感染或神经并发症。两组随访临床结果和解剖复位率无显著差异。但A组术中情况和术后效果优于B组，B组术后X线片滑脱角度和椎间盘指数参数优于A组。
轻度腰椎滑脱性腰椎管狭窄症的最佳手术治疗方法是术中彻底减压性椎板切除术、使用优良的经椎弓根系统器械复位并植骨后坚固融合。椎间融合器的使用应符合严格的适应证。
