关键词: 腰椎, 融合, 椎弓根螺钉, 减压, 邻近节段退变

Abstract:

BACKGROUND: With the development of spinal internal fixation and spinal fusion technology, spinal fusion has become undisputed “gold standard” of lumbar degenerative spondylolisthesis. Meanwhile, the problem of adjacent segment degeneration attracts more and more attention.
OBJECTIVE：To observe the clinical effect, the stability of surgical segment, and their influences on adjacent segments of pedicle screw fixation and fusion in treatment of degenerative spondylolisthesis, and to compare with simple vertebral canal compression.
METHODS: A total of 38 patients with lumbar degenerative spondylolisthesis received treatment at the Department of Orthopaedics, General Hospital of Tianjin Medical University were selected, and 3 patients were lost in follow-up. Of the remaining 35 cases, 21 cases underwent pedicle screw fixation posterolateral fusion and 14 cases underwent simple vertebral canal decompression. Simple vertebral canal compression group treated with the rongeur bite yellow ligament and lamina to relieve nerve root compression, forward vertebral slippage of adjacent vertebral body with posterior inferior formation relative prominence was chiseled with osteotome. According to Wein-stein method pedicle screw into the needle localization, then screw into the pedicle screw and undergo vertebral plate decompression on the basis of compression condition in pedicle screw fixation and fusion group. The clinical effect underwent comprehensive evaluation of oswestry dysfunction index; horizontal displacement and angular displacement were observed at hyperextension and flexion time. Degenerative condition of adjacent segment was evaluated by UCLA system.
RESULTS AND CONCLUSION: A total of 35 patients were followed up for 1 year. The excellent rate in pedicle screw fixation and fusion group was significantly higher than that in simple vertebral canal compression group (P < 0.05). Pedicle screw fixation and fusion has little effect on the stability of lumbar. There was no significant change in adjacent segment before degenerative insertion and 1 year after insertion. Simple vertebral canal compression had a significant effect on the stability of lumbar, and there was no significant change in adjacent segment degeneration before treatment and 1 year after treatment. It is indicated that pedicle screw fixation and fusion has satisfying effects in treatment of degenerative spondylolisthesis, and has less influence on stability of lumbar, which has little effect on adjacent segments of intervertebral discs after insertion in early stage.