两种后路椎间植骨方法治疗腰椎滑脱的疗效比较研究(英文)

Comparison of Clinical Outcomes Between Two Methods of Posterior Lumbar Interbody Fustion in Adult Spondylolisthesis

目的 探讨后路椎间融合（pasterior lumber interbody fusion，PLIF）应用Cage及椎弓根钉技术后，有无必要加用椎间自体植骨治疗腰椎滑脱。方法 2003年3月～2004年3月，对27例腰椎滑脱症患者行后路椎间植骨融合术。采用Cage及椎弓根钉技术治疗15例（A组），其中男4例，女11例；年龄53～68岁。病变部位位于L4节段9例，L5节段6例；术前平均椎间隙高度为5．4±2．3mm，平均滑脱率为36．8％±7．2％。采用Cage及椎弓根钉技术加用椎间自体植骨治疗12例（B组），其中男3例，女9例；年龄53～65岁。病变部位位于L4节段8例，L5节段4例；术前平均椎间隙高度为5．7±2．5mm，平均滑脱率为37．8％±6．2％。对两组患者进行失血量、住院日、疼痛度和缓解程度、融合率及并发症，以及术后椎间隙高度、滑脱率及融合率进行分析比较。结果术后患者均获随访24～38个月，A组随访时间24-36个月，B组随访时间24～38个月。两组患者随访时间，性别，病变部位，术前椎间隙高度，平均滑脱率，失血量，住院日，融合时间均无统计学差异（P〉0．05）；但疼痛度及缓解程度、融合率，B组均好于A组，差异有统计学意义（P〈0．05）。A组最后随访平均椎间隙高度5．8±2．2mm，平均滑脱率为25．6％±7．2％，B组为6．2±2．5mm和24．1％±7．4％，两组比较差异有统计学意义（P〈0．05）。结论 PLIE手术应用Cage及椎弓根钉技术加用椎间自体植骨，有助于恢复和保持腰骶椎生理曲度，防止后期的椎间隙高度丢失及滑脱率的增加，可能利于手术后长期疗效的保持。

Objective To compare the clinical outcomes of posterior lumbar interbody fusion（PLIF） using simple cage alone fusion with pedide screw fixation and autogenous bone grafting and cage fusion with pedide screw fixation in adult spondylolisthesis. Methods From March 2003 to March 2004,Twenty-seven patients with lumbar spondylolisthesis were divided in two groups. In group A, 15 patients were treated by PLIF using simple cage alone fusion with pedide screw fixation, including 4 males and 11 females, aging 53-68 years. Isthmic defects were located at L4 in 9 cases, at L5 in 6 cases. Four patients were smokers. The preoperative mean disc space height was 5.4 ± 2.3 ram, the mean percentage of slip was 36.8% ± 7.2%. In group B, 12 patients were treated by PLIF using autogenous bone grafting and cage fusion with pedide screw fixation, including 3 males and 9 females, aging 56 years. Isthmic defects were located at L4 in 8 eases, at L5 in 4 eases. Five patients were smokers. The preoperative mean disc space height was 5.7 ± 2.5 ram, the mean percentage of slip was 37.8% ± 6.2%. Two groups were compared in the amount of blood loss, duration of hospi- talization, back pain, radiating pain, fusion rate, the intervertebral disc space height, the postoperative degree of slip and the fusion rate. Results All patients were followed up for 24-38 months. The mean follow-up was 29（24-36） months in group A and 26（24-38） months in group B. There were no statistically significant differences in follow-up period, age,sex, the location of isthmie defects, smoking, the preoperative disc space height and the percentage of slip between two groups （ P 〉 0.05）. There were no statistically significant differences in the amount of blood loss, the duration of hospitalization, the fusion time between two groups（ P 〉 0.05）. But there were statistically significant differences in the back pain score, the radiating pain score and the fusion rate between two groups（ P 〈 0.05）. The postoperative disc space height and the degree of slip of the last follow-up were 5.8 ± 2.2 mm and 25.6% ± 7.2% in group A, 6.2±2.5remand24.1%±7.4 % in groupB, showing statisfieally significant difference （P〈0.05）. Conclusion The PLIFusing autogenous bone grafting and cage fusion with pediele screw flxatious is more beneficial to improving the fusion rate and preventing long- term instabilities than simple cage alone fusion with pediele screw fixation in adult spondylolisthesis.