Poussa M, Schlenzka D, Seitsalo S, Ylikoski M, Hurri H, Osterman K
Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland.
Spine (Phila Pa 1976). 1993 Jun 1;18(7):894-901. doi: 10.1097/00007632-199306000-00014.
Twenty-two adolescent patients with severe (more than 50%) slip were surgically treated. Eleven were reduced with Magerl/Dick transpedicular screw devices and fused posteriorly from L4 to S1, and 2 weeks later anteriorly L5-S1; the other 11 were fused in situ L4-S1 (6 patients) or L5-S1 (5 patients) using a circumferential (6 patients), anterior (4 patients) or posterolateral (1 patient) technique without instrumentation. The two groups were comparable as to age at operation, age at follow-up, follow-up time, and preoperative radiologic measurement of the slip, lumbosacral kyphosis, and clinical findings. The mean follow-up times were 56.5 and 59.8 months, respectively. In the reduction group an improvement in the slip of 36.1 percentage points was achieved as compared with 7.7 percentage points in the in situ-fusion group. The sagittal rotation angle improved by 11 in the reduction group and worsened by 2.8 in the in situ-fusion group. There were no differences between the groups in the functional tests or clinical findings concerning pain. Subjective assessment was good in both groups at follow-up; that is, the pain had disappeared. Mean operation time and intraoperative blood loss were significantly higher in the reduction group. Reduction procedures were also associated with a higher number of complications and reoperations. No neurologic complications, however, occurred in the reduction group. Based on this study, in situ fusions are to be preferred in adolescents with severe spondylolisthesis.
22例严重（滑脱超过50%）的青少年患者接受了手术治疗。11例患者采用Magerl/Dick椎弓根螺钉装置进行复位，并从L4至S1进行后路融合，2周后再进行L5 - S1前路融合；另外11例患者采用环形（6例）、前路（4例）或后外侧（1例）技术在L4 - S1（6例患者）或L5 - S1（5例患者）原位融合，未使用内固定器械。两组在手术年龄、随访年龄、随访时间以及术前滑脱、腰骶后凸的影像学测量和临床表现方面具有可比性。平均随访时间分别为56.5个月和59.8个月。复位组的滑脱改善了36.1个百分点，而原位融合组为7.7个百分点。复位组的矢状面旋转角度改善了11°，原位融合组则恶化了2.8°。两组在功能测试或疼痛相关的临床表现方面没有差异。随访时两组的主观评估都很好，即疼痛已经消失。复位组的平均手术时间和术中失血量明显更高。复位手术还伴随着更多的并发症和再次手术。然而，复位组未发生神经并发症。基于这项研究，对于严重腰椎滑脱的青少年患者，原位融合术更值得首选。
