Objective: To study the method of spine sequence reconstruction with pedicle screw system in high-grade lumbar spondylolisthesis and make prospective analysis. Methods: 31 patients of high-grade lumbar spondylolisthesis in our hospital from March 2006 to May 2008 were treated with spinal decompression, implant screws, alternating bilateral slow pry, fixed after vertebral body reset, intervertebral implant cage. Before and after treatment, pain conditions of patients were evaluated by visual analog scale (VAS), and lumbar lordosis (LL), sacral slope (SS), pelvic tilt angle (PT) were measured by imaging. Results: After treatment, 26 patients completed the anatomic reduction, 5 cases with grade IV spondylolisthesis reduced to the grade I . All graft bone with good fusion, 2 patients with transient postoperative radicular pain, 1 patient with screw breakage. The pain scores of all patients in 1, 2, 3 years after surgery [(0.8±0.2), (0.9±0.1), (1.0±0.1) scores]were significantly reduced compared with before surgery [(7.8±0.5) scores], the differences were statistically significant (P<0.05), and LL, SS, PT improved significantly after treatment[(58.2±10.6)°, (43.8±6.0)°, (11.9±3.2)° vs (72.5±13.7)°, (55.1±3.9)°, (16.8±2.7)°] (t=8.65, 8.37, 9.13, P<0.05). Conclusion: The effect of pedicle screw system in the treatment of severe spondylolisthesis and spine sequence reconstruction is better; and LL, SS, PT are closely related to postoperative outcome, should be measured in and after surgery.%目的:研究重度腰椎滑脱患者采用椎弓根螺钉固定进行脊柱序列功能重建的方法,并进行前瞻性分析.方法:选择我院2006年3月~2008年5月收治的重度腰椎滑脱患者31例,椎管减压后,植入螺钉,双侧椎间隙交替缓慢撬拨,达到椎体复位后固定,重建脊柱序列,椎间隙植入cage.术后采用视觉模拟评分(VAS)评定患者疼痛情况,影像检查,测量腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆倾斜角改变(PT).结果:本组31例患者中,26例完成解剖复位,5例由Ⅳ度滑脱复位至Ⅰ度.全部患者术后椎间植骨融合良好,2例患者术后出现短暂神根性疼痛,术后随访1例患者出现螺钉断裂.全部患者术后1、2、3年疼痛评分[(0.8±0.2)、(0.9±0.1)、(1.0±0.1)分]较术前[(7.8±0.5)分]明显降低,前后比较,差异有统计学意义(F=12.17,P<0.05),全部患者术后LL[(58.2±10.6)°]、SS[(43.8±6.0)°]、PT[(11.9±3.2)°]均较术前[(72.5±13.7)°,(55.1±3.9)°,(16.8±2.7)°]改善,前后比较,差异有统计学意义(t=8.65、8.37、9.13,P<0.05).结论:椎弓根螺钉系统器械复位治疗重度腰椎滑脱,恢复脊柱序列,效果较好;腰椎骨盆各角度恢复情况与术后转归有密切关系,应注意检测.
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