退行性腰椎滑脱后路手术临床分析

Clinical Study of Posterior Surgical Treatment for Degenerative Lumbar Spondylolisthesis

目的探讨退行性腰椎滑脱的后路手术治疗,比较后路腰椎管减压内固定并后外侧植骨及椎体间联合后外侧植骨术的临床疗效。方法37例退行性腰椎滑脱患者采用后路减压、后外侧植骨内固定(A组21例)和椎体间联合后外侧植骨内固定(B组16例)手术,对两组术后植骨融合率及临床症状改善情况进行分析比较。根据术前、术后X线片和JOA评分评价植骨融合率及临床症状改善程度。结果平均随访42个月。A组骨融合率为86%,B组为94%,两组无显著性差异。A组JOA评分优良率为90%,B组为94%,两组无显著性差异。结论后路后外侧植骨内固定和椎间联合后外侧植骨内固定术均是有效的手术方法,但椎间联合后外侧植骨融合术的骨融合率较高。

Objective To study the posterior surgical treatment for lumbar decompression with arthrodeais and pedicle screw fixation in degenerative lumbar spondylolistheais and compare the effectiveness of two methods for stabilization and fusion： posterolateral fusion and interbody fusion with posterolateral fusion. Methods Followup study was performed in a series of 37 patients undergoing arthrodeais and pedicle screw fixation. Twenty - one patients in group A had been treated with posterolateral fusion while 16 patients in group B were treated by interbody fusion and posterolateral fusion. These two groups were compared for clinical outcome and fusion rate by X-ray and the Japanese Orthopedic Associate （JOA） score. Results The patients were followed up for 42 months on average. The bone union rate in group A and B was 86 % and 94 % respectively. The excellent and good result rate of JOA score was 90 % in group A and 94 % in group B. There were no significant differences in the bone union rate and the JOA score between two groups. Conclusion The two surgical techniques of posterolateral fusion and interbody with posterolateral fusion combined with posterior lumbar decompression and pedicle screw fixation are effective for treatment of degenerative lumbar spondylolistheais. However, the bone union rate is higher in interbody with posterolateral fusion group.