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目的 评价Ⅲ、Ⅳ度腰椎滑脱手术治疗疗效.方法 2009年10月-2013年5月采用椎体椎弓根固定、后方全椎板减压并椎体间融合治疗Ⅲ、Ⅳ腰椎滑脱40例.术后随访24～33个月,平均27个月,通过对手术前后的滑脱率、腰椎前凸角、骨盆入射角、后椎间隙高度、骶骨倾斜角等指标的测量,结合一次性行走距离和VSA评分来评估临床疗效.结果 术前滑脱率(65.5±2.3)％,术后即时(10.5±2.5)％,末次随访(12.0±2.3)％.末次随访滑脱率与术前比有统计学意义(P＜0.01),与术后即时比差异无统计学意义(P＞0.05).腰骶段-骨盆参数(PI、PT、LL、SS)均有不同程度的改善,术前平均一次性行走距离(300±15)m,术后1年一次性行走距离(1500±50)m,手术前后差异有统计学意义(P＜0.01).术前VSA评分平均为(8.6±0.2),术后半年平均分(1.2±0.3),术后一年平均分(1.0±0.2),末次随访(一年以上)平均得分(1.0±0.2),手术前后差异有统计学意义(P＜0.01).临床治疗效果满意.结论 椎体椎弓根固定、后方全椎板减压并椎体间融合是治疗Ⅲ、Ⅳ度腰椎滑脱的有效方法.“,”Objective To evaluate the effect of surgical treatment for spondylolisthesis of the third and fourth degree.Methods From Oct 2009 to May 2013 totally 40 cases of spondylolisthesis were treated with vertebral pedicle fixation,posterior decompression and interbody fusion.Patients were followed up for 24 ～ 33 months,average 27 months.Measured the slip rate of before and after the operation,pelvic incidence,intervertebral height and sacral inclination angle index,combined with disposable walking distance and VSA score to evaluate the clinical curative effect.Results The preoperative spondylolisthesis rate was (65.5 ± 2.3) ％,the immediate postoperative time was (10.5 ± 2.5) ％,and the final follow-up was (12.0 ± 2.3) ％.The rate of spondylolisthesis at the last follow-up was statistically significant (P ＜0.01),and there was no significant difference (P ＞ 0.05).Lumbosacral-pelvic parameters (PI,PT,LL,SS)were improved,the average preoperative disposable walking distance was (300 ± 15) meters,after 1 years of disposable walking distance was (1500±50) meters,the difference was statistically significant before and after operation (P ＜0.01).The mean preoperative VSA score was (8.6 ±0.2),an average of 6 months after surgery (1.2 ± 0.3),after one year the average (1.0 ± 0.2),at the end of the follow-up (one year) the average score (1.0 ± 0.2),statistically significant differences were found between before and after operation (P ＜ 0.01).The effect of clinical treatment was satisfactory.Conclusion Vertebral pedicle fixation,posterior decompression and interbody fusion were effective methods for the treatment of spondylolisthesis.