CAJ | 학술논문

背景：腰椎滑脱症的治疗目的是重建脊柱序列和椎体稳定性，解除神经压迫，达到永久腰椎融合的作用。目的：探讨腰椎滑脱症患者腰椎融合及植入物内固定后椎体稳定性的恢复。 　　方法：腰椎滑脱症最常采用Wiltse分型将其分为发育不良性、峡部裂性、退变性、创伤性以及病理性，将腰椎侧位X射线片的上位椎体相对于下位椎体的滑移程度分为5级，根据腰椎滑脱症患者的分型和分级以及患者具体情况选择适宜的治疗方式。 　　结果与结论：坚强融合内固定，植入物与椎体间是刚性连接，常用来稳定脊柱、矫正畸形，骨融合率较高，减少了假关节形成。动态融合内固定是用弹性材质或微动装置分散坚强内固定负荷传导，减少应力遮挡效应及邻近节段的应力集中。动态非融合内固定能改变脊柱运动节段的负荷传递方式，阻止脊柱运动，预防邻近节段退变，使失稳的腰椎达到其正常状态的活动特性，实现动态重建腰椎序列。峡部关节缺损部位直接修复植骨，适用于青壮年有症状不伴有退行性椎间盘疾病的滑脱患者。腰椎滑脱症选择哪种材料植骨和植骨部位以及哪种入路方法融合和植入物内固定可以得到理想的融合内固定效果一直是学者们争论的焦点，目前尚未达成统一。
　　배경：요추활탈증적치료목적시중건척주서렬화추체은정성，해제신경압박，체도영구요추융합적작용。목적：탐토요추활탈증환자요추융합급식입물내고정후추체은정성적회복。 　　방법：요추활탈증최상채용Wiltse분형장기분위발육불량성、협부렬성、퇴변성、창상성이급병이성，장요추측위X사선편적상위추체상대우하위추체적활이정도분위5급，근거요추활탈증환자적분형화분급이급환자구체정황선택괄의적치료방식。 　　결과여결론：견강융합내고정，식입물여추체간시강성련접，상용래은정척주、교정기형，골융합솔교고，감소료가관절형성。동태융합내고정시용탄성재질혹미동장치분산견강내고정부하전도，감소응력차당효응급린근절단적응력집중。동태비융합내고정능개변척주운동절단적부하전체방식，조지척주운동，예방린근절단퇴변，사실은적요추체도기정상상태적활동특성，실현동태중건요추서렬。협부관절결손부위직접수복식골，괄용우청장년유증상불반유퇴행성추간반질병적활탈환자。요추활탈증선택나충재료식골화식골부위이급나충입로방법융합화식입물내고정가이득도이상적융합내고정효과일직시학자문쟁론적초점，목전상미체성통일。
BACKGROUND:The purpose of the treatment of lumbar spondylolisthesis is to reconstruct the spine sequence and vertebral stability, relieve nerve compression, and achieve permanent lumbar fusion. OBJECTIVE:To explore the restore of vertebral stability of the lumbar spondylolisthesis patients after lumbar fusion and implant internal fixation. METHODS:The lumbar spondylolisthesis was often divided into dysplastic, isthmic, degenerative, traumatic and pathological with Wiltse classification. The slip degree of upper vertebra relative to lower vertebra on the lumbar X-ray film was divided into five grades, and then the appropriate treatment method was selected according to the classification, grading and specific circumstances of the lumbar spondylolisthesis patients. RESUTLS AND CONCLUSION:The strong fusion and internal fixation and the rigid connection between implants and vertebra are often used to stabilize the spine and correct deformities with high bone fusion rate, thus reducing pseudoarticulation formation. Dynamic fusion and internal fixation can distribute the load conduction of rigid internal fixation with elastic material or micro-devices, thus reducing stress shielding and adjacent segment stress concentration. Dynamic non-fusion and internal fixation can change the load transfer mode of spinal motion segment, inhibit spinal movement and prevent adjacent segment degeneration, in order to make the instable lumbar spine reach its normal activity characteristics, and achieve dynamic reconstruction of lumbar sequence. Lumbar isthmus defects directly repaired with graft is suitable for the young adult with the symptoms of lumbar spondylolisthesis and without degenerative disc disease. There is no consistent option on which materials and position is suitable for graft in the lumbar spondylolisthesis patients, as wel as which methods for fusion and implant internal fixation can achieve ideal effect.