Zhang Wenzhi, Shang Xifu, Duan Liqun, Xu Xiang, Hu Yefeng, Yao Gang
The 2nd Department of Orthopedics, Anhui Provincial Hospital, Hefei Anhui 230001, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Oct;24(10):1153-8.
To evaluate the mid-term clinical outcome of instrumented slip reduction combined with 360 degrees circumferential fusion and restoration laminae for symptomatic adult isthmic spondylolisthesis.
Between October 2004 and March 2008, 44 patients with symptomatic isthmic spondylolisthesis underwent instrumented slip reduction combined with 360 degrees circumferential fusion and restoration laminae. There were 15 males and 29 females with an average age of 38.4 years (range, 28-45 years). The disease duration was 14 months to 7 years (38 months on average). The affected vertebrae was L4-5 in 18 patients and L5, S1 in 26 patients. According to Meyerding's grade for spondylolisthesis, 28 cases were rated as grade II and 16 as grade III. The visual analogue scale (VAS), Oswestry disability index (ODI), and the short form 36 health survey (SF-36) scores were evaluated before operation and at last follow-up; the radiographical outcome was evaluated by measuring slipping percentage, heights of intervertebral space and foramen, and fusion rate. RESULTS; All patients were followed up 20-60 months (42 months on average). The VAS, ODI, and SF-36 scores were all significantly improved at last follow-up when compared with those before operation (P < 0.05). According to Morelos criteria, the clinical results were excellent in 32 patients, good in 9, and fair in 3; the excellent and good rate was 93.2%. The preoperative average percentage of slip was 47.5%, which was improved to 2.6% 3 days after operation; the total average reduction rate was 97.4%, and it was maintained at last followup. The heights of intervertebral space and foramen were all improved significantly after operation (P < 0.05), and there was no significant difference between at 3 days after operation and at last follow-up (P > 0.05). X-ray and CT showed bony fusion 1 year after operation in all patients with a fusion rate of 100%. Complications included pain at donor site of iliac bone in 4 cases, superficial infection in 2 cases, dural tear in 1 case, and degeneration of adjacent vertebrae in 2 cases; no nerve root injury, pseudoarthrosis, failure of internal fixation, and acquired spinal canal stenosis occurred. CONCLUSION; Instrumented slip reduction combined with 360 degrees circumferential fusion and restoration laminae is a reliable procedure for adult isthmic spondylolisthesis with satisfactory mid-term results, a high fusion rate and low complication rate. The long-term outcomes should be verified by follow-up in the future.
评估器械辅助滑脱复位联合360度环形融合及椎板重建治疗有症状的成人峡部裂性腰椎滑脱症的中期临床疗效。
2004年10月至2008年3月，44例有症状的峡部裂性腰椎滑脱症患者接受了器械辅助滑脱复位联合360度环形融合及椎板重建手术。其中男性15例，女性29例，平均年龄38.4岁（范围28 - 45岁）。病程为14个月至7年（平均38个月）。18例患者病变椎体为L4 - 5，26例为L5、S1。根据Meyerding腰椎滑脱分级，Ⅱ度28例，Ⅲ度16例。分别于术前及末次随访时评估视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）及简明健康调查量表（SF - 36）评分；通过测量滑脱百分比、椎间隙及椎间孔高度和融合率评估影像学结果。结果：所有患者均获随访20 - 60个月（平均42个月）。末次随访时VAS、ODI及SF - 36评分均较术前显著改善（P < 0.05）。根据Morelos标准，临床结果优32例，良9例，可3例；优良率为93.2%。术前平均滑脱百分比为47.5%，术后3天改善至2.6%；总平均复位率为97.4%，且在末次随访时维持该水平。术后椎间隙及椎间孔高度均显著改善（P < 0.05），术后3天与末次随访时比较差异无统计学意义（P > 0.05）。X线及CT显示所有患者术后1年均获得骨性融合，融合率为100%。并发症包括髂骨取骨部位疼痛4例，浅表感染2例，硬膜撕裂1例，相邻椎体退变2例；未发生神经根损伤、假关节形成、内固定失败及获得性椎管狭窄。结论：器械辅助滑脱复位联合360度环形融合及椎板重建是治疗成人峡部裂性腰椎滑脱症的可靠方法，中期疗效满意，融合率高，并发症发生率低。长期疗效有待进一步随访验证。
