后路椎间融合术治疗成人腰椎滑脱的前瞻性研究

Posterior lumbar interbody fusion for adult spondylolisthesis: a prospective comparative study

目的前瞻性比较采用自体髂骨块和椎间融合器治疗成人腰椎滑脱的效果。方法自1998年2月～2002年2月治疗78例腰椎滑脱患者,所有患者均行椎弓根螺钉固定、后路椎间融合术,根据椎间融合材料的不同,前瞻性将患者随机分为融合器组36例(采用后方斜向单枚椎间融合器)和自体骨组42例(采用自体髂骨块)。男33例,女45例;年龄35～59岁,平均43岁。其中Ⅰ度滑脱29例,Ⅱ度滑脱39例,Ⅲ度滑脱10例。比较两组患者的基本情况、临床效果和影像学结果(融合率和手术节段椎间隙高度的变化)。结果术后随访2年～3年7个月,平均35个月。两组在性别、年龄、滑脱程度、手术时间、失血量以及住院时间上差异无显著性,两组患者均无严重并发症。融合器组优良率为88.8%,自体骨组为83.2%(P=0.99)。术后1年融合器组的融合率为86.1%,自体骨组为83.3%,两组间差异无显著性意义(P=0.87);最终随访时椎间隙高度融合器组平均减少1.7 mm,自体骨组平均减少2.6 mm,两组间差异有非常显著性意义(t=1.38,P< 0.005)。结论采用自体骨为植骨材料者术后椎间隙高度丢失明显增加,但两组之间融合率和临床优良率差异无显著性。椎间融合器和自体髂骨块均可以作为腰椎滑脱后路椎间融合的植骨材料,临床疗效好。

Objective To prospectively compare the clinical and radiographic results of adult spondylolisthesis treated with instrumentation and interbody fusion utilizing iliac crest or interbody fusion cage. Methods From February 1998 to February 2002, 78 patients with adult spondylolisthesis were treated with posterior lumbar interbody fusion and pedicle screw fixation. There were 33 males and 45 females with an average age of 43 years ranging from 35 to 59 years. Of 78 patients, 32 were diagnosed as degenerative spondylolisthesis, and 46 were isthmic spondylolisthesis. The patients were randomly divided into two groups according to the material used for interbody fusion. There were 36 patients utilizing interbody fusion cages (Group A), and 42 patients utilizing iliac crest (Group B). The clinical and radiographic results of the patients were compared between two groups. Results All patients were followed from 2 years to 3 years and 7 months with an average of 35 months. There were no significant differences between two groups regarding the sex, age, degree of spondylolisthesis, surgical time, blood loss and hospital stay. There were no severe complication occurred in the two groups. The rate of satisfactory clinical results was 88.8% for group A and 83.2% for Group B without significant difference. One year post-operatively, the fusion rate was 86.1% for group A and 83.3% for group B without significant difference. At the last follow up, the average loss of disc space height was 1.7 mm for Group A and 2.6 mm for Group B with significant difference. Conclusion Although there is significant loss of disc space height in patients utilizing iliac crest comparing to the patients utilizing interbody fusion cages, the fusion rate and satisfactory rate of clinical results are no significant different. Both iliac crest and interbody fusion can be used for interbody fusion for the treatment of adult spondylolisthesis and successful clinical outcome can be achieved. [