PLIF与TLIF治疗腰椎不稳症的疗效比较

Posterior lumbar interbody fusion versus transforaminal lumbar interbody fusion with pedicle screw system for severe lumbar instable disorders

目的对比研究后路腰椎椎体间植骨融合术（posterior lumbar interbody fusion，PLIF）与经腰椎间孔入路腰椎椎间植骨融合术（transforaminal lumbar interbody fusion，TLIF）治疗腰椎不稳症的疗效。方法1999年2月～2006年3月，217例重度退变性腰椎不稳症患者接受腰椎后路椎间植骨融合，辅以相应节段椎弓根钉内固定术，其中76例经腰椎间孔椎体间植骨融合（TLIF组），另外141例经腰椎管内（硬脊膜外）椎体间植骨融合（PLIF组），比较两组手术方式的临床疗效、植骨融合率及手术并发症。结果217例患者手术切口均一期愈合，无椎间隙感染、下肢深静脉栓塞等并发症。PLIF组128例患者经6～82个月随访，平均64个月，发生硬脊膜撕裂4例，脑脊液漏1例，马尾神经及神经根一过性牵拉损伤3例。TLIF组67例经4～56个月随访，平均36个月，未发生神经损伤等并发症。两组平均手术时间、术中平均出血量、平均住院时间均无明显差异。TLIF组与PLIF组的临床优良率分别为89．86％和86．72％，两者无显著性差异（P〉0．05），植骨融合率分别为92．75％和93．75％，两者无显著性差异（P〉0．05）。结论经腰椎间孔入路椎间植骨融合术治疗腰椎不稳症，不但技术操作可行，而且能明显降低因侵入椎管而带来的各种并发症，是治疗重度退变性腰椎不稳症的有效手术方式。

Objective To evaluate the outcome of posterior lumbar interbody fusion （PLIF） versus transforaminal lumbar interbody fusion （TLIF） with pedicle screw system for severe lumbar instable disorders. Methods From February 1999 to March 2006, 217 patients with severe lumbar instable disorders were treated with posterior lumbar intervertebral bone grafting, interhody fusion and pedicle screw fixation. One group （141 patients） underwent PLIF while patients in the other group （76 cases） underwent TLIF. The clinical outcome and fusion rate in these two groups were compared. Results The excellent and good rate was 86.72% in PLIF group and 89.86% in TLIF group （P 〉 0.05）. The fusion rate was 93.75% in PLIF group and 92.75% in TLIF group. The complications of the TILF group were lower than those of the PLIF group. Conclusion The technique of the transforaminal lumbar interbody fusion （TLIF） is feasible for the treatment of the severe lumbar instability. It is helpful in reducing the epidural fibrosis and scar formation. The technique of the TLIF with the pedicle screw fixation has a good clinical effect on severe lumbar instable disorders in the operation.