Ruf M, Melcher R, Merk H, Harms J
Orthopädie und Traumatologie, Wirbelsäulenchirurgie, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany.
Z Orthop Ihre Grenzgeb. 2006 Jan-Feb;144(1):33-9. doi: 10.1055/s-2005-918189.
Developmental spondylolisthesis leads to lumbosacral kyphosis with retroversion of the sacrum and lumbar hyperlordosis. The overall sagittal profile of the spine is affected. The deformity is progressive during growth. This retrospective study describes a technique for complete reduction with clinical and radiological evaluation.
Thirty-four patients (mean age 16 years 3 months, 10 males, 24 females) with severe developmental spondylolisthesis L5/S1 (Meyerding grades 3 to 5) were operated on between February 1997 and July 2002.
Reduction was achieved by temporary transpedicular instrumentation of L4. These screws were removed at the end of the operation or 12 weeks later.
Mean slippage was corrected from 76 % preoperatively to 10 % postoperatively. Segmental kyphosis L5/S1 improved from + 21 degrees preoperatively to - 7 degrees postoperatively. Sacral inclination was 34 degrees preoperatively, 43 degrees postoperatively, and 47 degrees at latest follow-up. 76 % of the patients were pain free at the latest follow-up. In 4 patients a fusion at L4/5 was performed due to subsequent decompensation.
The technique described allows for a nearly anatomic reduction with correction of slippage as well as segmental kyphosis. Correction of the local deformity with monosegmental fusion L5/S1 improves dramatically the overall sagittal profile of the spine. Fusion of the primarily healthy segment L4/5 can be avoided.
发育性腰椎滑脱会导致腰骶部后凸，伴有骶骨后倾和腰椎前凸增大。脊柱的整体矢状面形态受到影响。该畸形在生长过程中呈进行性发展。本回顾性研究描述了一种实现完全复位并进行临床和影像学评估的技术。
1997年2月至2002年7月期间，对34例严重发育性L5/S1腰椎滑脱患者（平均年龄16岁3个月，男10例，女24例）进行了手术，滑脱程度为迈耶丁3至5级。
通过L4临时经椎弓根器械固定实现复位。这些螺钉在手术结束时或12周后取出。
平均滑脱率从术前的76%纠正至术后的10%。L5/S1节段后凸从术前的+21度改善至术后的-7度。骶骨倾斜角术前为34度，术后为43度，末次随访时为47度。76%的患者在末次随访时无疼痛。4例患者因随后出现失代偿而进行了L4/5融合术。
所描述的技术可实现近乎解剖学复位，同时纠正滑脱和节段性后凸。通过L5/S1单节段融合纠正局部畸形可显著改善脊柱的整体矢状面形态。可避免对原本健康的L4/5节段进行融合。
