摘要
目的：椎弓根钉棒系统内固定材料置入的应用，使腰椎滑脱症的手术治疗疗效有质的提高，但部分病例效果仍不尽人意。文章针对影响腰椎滑脱症手术疗效的内固定材料置入及植骨方式与宿主状态的相关因素进行分析与总结。
方法：①对象：选择2002-03/2006-09厦门大学附属中山医院和福建医科大学附属第二医院收治的腰椎滑脱症患者81例，男28例，女53例；年龄 26~83岁；病程6个月~20年。患者对所行手术知情同意。②手术过程：采用下腰部后正中纵形手术切口，椎弓根钉棒系统复位固定，后外侧植骨融合或环周融合（包括环周植骨融合与cage融合）。③评估：采用Logistic回归方法分析影响疗效的相关因素。
结果：81例患者均获得随访，随访时间6个月~2年16例，2~5年65例。①81例患者不完全复位15例，完全复位66例，复位率81.5%；术后椎间隙高度丢失14例，占总例数17.3%；术后滑脱丢失10例，占总例数12.3%。②术后JOA（Japan Orthopedic Association）评分优49例，良19例，中9例，差4例，优良率为84%。③Logistic回归分析结果，植骨方式对腰椎滑脱症临床疗效的影响差异无统计学意义（P > 0.10）；患者的性别，病程，滑脱的类型、程度、节段对腰椎滑脱症临床疗效的影响无统计学意义（P > 0.10）；患者的年龄，术后活动，椎间融合情况对临床疗效的影响有统计学意义（P < 0.05）。
结论：①滑脱完全复位与否，采用后外侧融合或环周融合的方式，以及患者的性别、病程、滑脱的类型、程度、节段不是影响疗效的因素。②患者的年龄、术后康复练习是影响手术疗效的重要因素，术后椎体间高度丢失、滑脱丢失与手术疗效有密切的关系。
关键词：椎间盘移位；回归分析；内固定器；组织构建

叶桂峰，林其仁.内固定材料置入及植骨方式与宿主相关状态影响腰椎滑脱手术疗效的分析[J].中国组织工程研究与临床康复，2008，12(9):1646-1650 [www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1646(ps).pdf]

Effect of fixation material and bone graft on the clinical outcome of surgical treatment for lumbar spondylolisthesis

Abstract
AIM: The application of pedicle screw system in the treatment of lumbar spondylolisthesis greatly improves the curative effect. However, there are still some problems. This study analyzed and summarized the correlation factors affecting the clinical outcome of surgical treatment for lumbar spondylolisthesis.
METHODS: ①From March 2002 to September 2006, 81 patients with lumbar spondylolisthesis were selected from Zhongshan Hospital of Xiamen University and Second Hospital of Fujian Medical University. There were 28 males and 53 females, aged 26–83 years and illness course of 6 months to 20 years. The informed consent was obtained from all subjects. ②All patients took a posterior median longitudinal incision in the lower back, and fixed with pedicle screw system, fused by the way of posterolateral or circumferential bone graft (including circumferential fusing and cage fusing). The correlation factors were explored by means of Binary Logistic regression analysis.
RESULTS: All 81 patients were followed up, of which 16 were followed for 6 months to 2 years, and 65 for 2 to 5 years. ①In the 81 cases, 15 were incomplete reduction, and the residual 66 patients were anatomic reduction; the reduction rate was 81.5%. Postoperative intervertebral height decreased occurred in 14 cases, accounting for 17.3%, and postoperative slip in 10 cases, accounted for 12.3%. ②In Japan Orthopedic Association evaluation, it was excellent in 49 cases, good in 19, fair in 9, and poor in 4. The total excellence rate was 84%. ③The results of Binary Logistic regression analysis showed that there was no significant difference in the effect of bone graft approaches on the treatment of lumbar spondylolisthesis (P > 0.10); patient's sex, history of disease, type of spondylolisthesis, slippage degree and segment had no significant influence to the clinical outcome (P > 0.10). Such factors as the patient's age, postoperative exercises and fusion outcome were statistically significant to the clinical results (P < 0.05).
CONCLUSION: ①Anatomic reduction or not and the method of bone graft do not influence the clinical outcome, neither do the patient's sex, history of disease, type, severity or segment. ②Age and postoperative recovery exercises are key factors for the clinical outcome. Meanwhile, intervertebral height decrease and postoperative reduction of spondylolisthesis are closely correlated with the surgical outcome.

Ye GF, Lin QR.Effect of fixation material and bone graft on the clinical outcome of surgical treatment for lumbar spondylolisthesis. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(9):1646-1650(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1646(ps).pdf]