CAJ | 학술논문

背景：峡部裂性腰椎滑脱主要依靠手术治疗，治疗方式多种多样，但其目的是对病变节段进行减压、复位、固定、融合，治疗金标准为生物性融合，而内固定是融合治疗可靠的辅助方法。 　　目的：观察椎弓根螺钉系统内固定联合椎间融合器修复峡部裂性腰椎滑脱症的临床疗效。 　　方法：2010年3月至2013年3月应用椎弓根螺钉系统联合椎间融合器治疗峡部裂性腰椎滑脱症21例，其中Ⅱ度滑脱18例，Ⅲ度滑脱3例。对所有病例进行定期随访，以JOA评分及目测类比评分作为治疗后随访的客观疼痛评价标准，采用Macrab标准评定疗效，根据Prolo指标评价功能恢复，按Lenke标准评估脊柱融合率，通过影像学资料评估滑脱率、滑脱角、骶骨倾斜角和椎间隙后高在治疗前后的改变。 　　结果与结论：21例腰椎峡部裂性滑脱患者均获随访，随访时间12-16个月。所有患者JOA腰腿痛评分及腰腿痛目测类比评分均较治疗前改善，差异有显著性意义(P=0.000)。根据 Macrab 标准评定，本组优17例，良4例。Prolo活动、症状分级评价治疗前后比较差异有显著性意义(P=0.003)。治疗后腰椎滑脱基本复位，滑脱角明显减少，骶骨倾斜角增大，椎间隙高度基本恢复。提示椎弓根螺钉系统内固定联合椎间融合器是治疗峡部裂性腰椎滑脱症的有效策略之一。
배경：협부렬성요추활탈주요의고수술치료，치료방식다충다양，단기목적시대병변절단진행감압、복위、고정、융합，치료금표준위생물성융합，이내고정시융합치료가고적보조방법。 　　목적：관찰추궁근라정계통내고정연합추간융합기수복협부렬성요추활탈증적림상료효。 　　방법：2010년3월지2013년3월응용추궁근라정계통연합추간융합기치료협부렬성요추활탈증21례，기중Ⅱ도활탈18례，Ⅲ도활탈3례。대소유병례진행정기수방，이JOA평분급목측류비평분작위치료후수방적객관동통평개표준，채용Macrab표준평정료효，근거Prolo지표평개공능회복，안Lenke표준평고척주융합솔，통과영상학자료평고활탈솔、활탈각、저골경사각화추간극후고재치료전후적개변。 　　결과여결론：21례요추협부렬성활탈환자균획수방，수방시간12-16개월。소유환자JOA요퇴통평분급요퇴통목측류비평분균교치료전개선，차이유현저성의의(P=0.000)。근거 Macrab 표준평정，본조우17례，량4례。Prolo활동、증상분급평개치료전후비교차이유현저성의의(P=0.003)。치료후요추활탈기본복위，활탈각명현감소，저골경사각증대，추간극고도기본회복。제시추궁근라정계통내고정연합추간융합기시치료협부렬성요추활탈증적유효책략지일。
BACKGROUND:The main treatment of lumbar isthmic spondylolisthesis is the surgery, in a broader attempt to decompression, reduction, fixation and fusion of the lesioned segments. The golden standard of the treatment is biological fusion, while internal fixation is a reliable assistance for fusion therapy. OBJECTIVE:To discuss the clinical value and curative effect of intervertebral fusion cage combined with pedicle screw systems for the treatment of lumbar isthmic spondylolisthesis. METHODS:From March 2010 to March 2013, 21 cases of isthmic spondylolisthesis were treated with intervertebral fusion cage combined with pedicle screw systems, including 18 cases of spondylolisthesis of degree II and 3 cases of spondylolisthesis of degree III. Al patients were fol owed up regularly, taking JOA lumbago score and visual analog scale score as the objective evaluation criteria of pain in postoperative fol ow-ups. The curative effect was assessed by Macrab standard, and the functional recovery was evaluated based on indicators such as Prolo, and the spinal fusion rate was assessed according to Lenke criteria. Changes of slippage rate, slippage angle, sacral inclination angle and intervertebral space post height in preoperative and postoperative periods were evaluated by iconography data. RESULTS AND CONCLUSION:Al the 21 patients with isthmic spondylolisthesis were fol owed up for 12-16 months. JOA lumbago score and vasual analog scale score of al patients were improved after treatment, and the difference was statistical y significant compared with before treatment (P=0.000). According to Macrab evaluation criteria, there were 17 excellent cases and 4 good cases. Each indicator evaluated by preoperative Prolo activities and symptom grading showed significant differences in preoperative and postoperative periods (P=0.003). Postoperative lumbar spondylolisthesis was basical y reset, the slippage angle was significantly reduced, the sacral inclination angle was increased, and the height of the intervertebral space was recovered basical y. Intervertebral fusion cage combined with pedicle screw systems was one of the effective strategies to treat lumbar isthmic spondylolisthesis.