椎弓根器械复位固定后两种融合方法治疗腰椎滑脱症的疗效比较

Comparison between PLF and PLIF in the Treatment of Lumbar 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(后外侧融合)与PLIF(后路椎体间融合)对腰椎滑脱症的疗效。方法Ⅱ度以内腰椎峡部不连型滑脱共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(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(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 therapeutic effect between PLF and PLIF in the treatment of lumbar spondylolisthesis. Methods Forty-seven patients with lumbar spondylolisthesis at grades 1 or grade 2 were treated with pedical screw fixation and vertebrae fusion. Posterior lumbar fusion （PLF） was performed in 22 patients, and posterior lumbar interbody fusion （PLIF） was performed in 25 patients. The two groups were compared for clinical outcome （oswestry disability index, ODI）, radiographic date （include： correction of slippage, disc space height, segmental lordosis and fusion rate ） and complication rate. Results In 2-year follow-up, the maintains of correction of slippage and disc height in PLIF group was better than those in PLF group （P 〈 0.05）. The fusion rate and segmental lordosis in PLIF group was similar to PLF group （P 〉 0,05）. No significant difference was found in terms of clinical outcome （ODI） and complication rate （P 〉 0.05）. The hardware failure rate was higher in PLF group than in PLIF group. Conclusion Pedical screw fixation with PLF or PLIF are both effective for lumbar spondylolisthesis at low grade. Pedical screw fixation with PLIF confers superior mechanical strength in correction and maintain of spinal construct. Pedical screw fixation with PLF has more loss of reduction and higher failure rate of hardware, but the clinical outcome is not influenced.