椎弓根器械复位固定后两种不同融合方法对腰椎峡部裂型滑脱的疗效比较

Outcome compare between pedical screw fixation with PLF and with PLIF for isthmic spondylolisthesis

目的观察比较椎弓根器械复位固定后两种不同融合法PLF与PLIF对峡部裂型滑脱的疗效。方法Ⅱ度以内腰椎峡部裂型滑脱共47例,一组22例,椎弓根器械复位固定后行PLF(PLF组);另一组25例,椎弓根器械复位固定后行PLIF(PLIF组)。对两组的临床疗效(ODI评分)、X线影像学结果(包括:滑脱矫正、滑脱节段椎间隙高度改变、滑脱节段前突角改变及骨融合)及并发症进行对比观察。结果术后即刻X线影像学结果,包括:滑脱矫正、滑脱节段椎间盘高度、滑脱节段前突角,两组间无显著差异(P>0.05);术后2年随访时,滑脱矫正及滑脱节段椎间隙高度的维持上PLIF组优于PLF组(P<0.05),骨融合率及滑脱节段前突角两组间无显著差异(P>0.05),但两组间临床疗效(ODI评分)及并发症发生率无显著差异(P>0.05),内固定失败率PLF组高于PLIF组。结论椎弓根器械复位固定并PLF与PLIF都是治疗Ⅱ度以内腰椎峡部裂型滑脱的有效方法,PLIF在对滑脱矫形的维持及结构的稳定上具有优越的力学性能,PLF后期易出现矫正丢失及内固定失败,但临床疗效不受明显影响。

Objective To investigate and compare the outcome between pedical s crew fixation with PLF and with PLIF for isthmic spondylolisthesis. Methods 47 patients were treated with pedical screw fixation and spinal fusion for grades 1 and 2 isthmic spondylolisthesis. In 22 patients posterior lumbar fusion(PLF)was performed,and in 25 patients posterior lumbar interbody fusion (PLIF)was perfor med. Two groups were compared for clinical outcome(Oswestry disability index,ODI ),radiographic date(include:correction of slippage,disc space height,segmental l ordosis and fusion rate)and complication rate. Results At 2-year follow-up,the maintaince of correction of slippage and disc height in PLIF group was better th an in PLF group(P<0.05).The fusion rate and segmental lordosis in PLIF group was similar to PLF group (P>0.05). However,no statistical intergroup differences we re found in terms of clinical outcome(ODI)and complication rate(P>0.05). The har dware failure rate was high in PLF group. Conclusion Pedical screw fixation wit h PLF or with PLIF both are effective for low grade isthmic spondylolisthesis. P edical screw fixation with PLIF confers superior mechanical strength in correcti on and maintaince of spinal construct. Pedical screw fixation with PLF had signi ficant loss of reduction and high hardware failure rate,but the clinical outcome was not influenced.