Boos N, Marchesi D, Zuber K, Aebi M
Department of Orthopaedic Surgery, Inselspital University of Berne, Switzerland.
Spine (Phila Pa 1976). 1993 Sep 15;18(12):1655-61. doi: 10.1097/00007632-199309000-00014.
Ten consecutive patients with severe spondylolisthesis were treated with reduction and pedicular fixation (four Internal Fixator instrumentations, six Cotrel-Dubousset instrumentations). There were six Grade III spondylolisthesis and four spondyloptoses at the L5/S1 level. All patients had complete clinical and radiographic evaluation with an average follow-up of 56 months (range, 43-75 months). The percentage of slippage averaged 78.5% preoperatively and 39.6% postoperatively. The slip angle averaged 43 degrees preoperatively and 17 degrees postoperatively. Four patients with spondyloptosis were treated with combined posterolateral and interbody fusion and had solid fusion without loss of reduction. Five of six patients in whom reduction and stabilization was performed by a single posterolateral fusion demonstrated loss of reduction, nonunion, and implant failure. Four of these patients were reoperated. Ultimately all patients had resolution of pain, solid fusion, and no further slip progression. Reduction, pedicular fixation, and combined posterolateral and interbody fusion is a technically demanding procedure, which should be reserved for selected patients. Pedicular fixation systems may only allow permanent reduction and stabilization of high-grade spondylolisthesis in conjunction with a combined interbody and posterolateral fusion.
连续10例重度腰椎滑脱患者接受了复位及椎弓根内固定治疗（4例采用Internal Fixator内固定器械，6例采用Cotrel-Dubousset内固定器械）。L5/S1节段有6例Ⅲ度腰椎滑脱和4例腰椎椎体滑脱。所有患者均进行了全面的临床及影像学评估，平均随访56个月（范围43 - 75个月）。术前滑脱百分比平均为78.5%，术后为39.6%。术前滑移角平均为43度，术后为17度。4例腰椎椎体滑脱患者接受了后外侧融合与椎间融合联合治疗，实现了牢固融合且未出现复位丢失。6例通过单纯后外侧融合进行复位及稳定手术的患者中有5例出现了复位丢失、不愈合及内固定失败。其中4例患者接受了再次手术。最终所有患者疼痛均缓解，实现了牢固融合，且未出现进一步的滑脱进展。复位、椎弓根内固定以及后外侧融合与椎间融合联合治疗是一项技术要求较高的手术，应仅用于特定患者。椎弓根内固定系统可能仅在联合椎间融合与后外侧融合的情况下，才能实现高度腰椎滑脱的永久复位及稳定。
