两种椎间植骨融合术治疗退行性腰椎滑脱症的疗效比较

Comparative study on two different methods of lumbar interbody fusion with pedide screw fixation for the treatment of spondylolisthesis

目的比较腰椎经椎间孔椎间植骨融合术（TLIF）与腰椎后路椎间植骨融合术（PLIF）治疗退行性腰椎滑脱症的效果。方法对120例腰椎滑脱症患者分别采用TLIF（60例）与PLIF（60例）。回顾两组患者的临床资料，比较两种植骨方式术后植骨融合率及临床症状改善情况。结果随访16～35个月（平均23个月）。所有手术均获得成功。所有患者所有节段均获骨性融合，未见融合器后移及沉陷。无并发感染。JOA评分：TLIF组优良率83．3％，PLIF组优良率81．7％，两组差异无统计学意义（P〉0．05）。手术总优良率为82．5％。滑脱率、复位率术后与术前比较都有明显改善（P〈0．01）；两组复位率丢失程度相似（P〉0．05）。椎间隙高度及椎间孔高度：术前、术后相比差异有统计学意义（P〈0．01），两组之间相比差异无统计学意义（P〉0．05），两组丢失率相近（P〉0．05）。结论TLIF与PLIF治疗腰椎滑脱症的疗效相近，TLIF单侧植入椎间融合器，较PLIF简便安全。

Objective To compare the clinical outcome of transforaminal lumbar interbody fusion （TLIF） and posterior lumbar interbody fusion （PLIF） with pedicle screw fixation on the treatment of spondylolisthesis. Methods One hundred and twenty patients with spondylolisthesis who were managed in our department were retrospectively evaluated. They were categorized into TLIF group and PLIF group according to the surgical methods, with 60 cases in each group. The slippage rate, the height of intervertebral space and intervertebral foramen were measured in each patient before and after operation and were compared between the two groups correspongdingly. The interbody fusion rate, JOA score and complications after operation were also determined. Results All the 120 patients were followed up for an average of 23 months （range, 16 to 35 months）. Interbody bony fusion was achieved in every case and cage excursion or subsidence occurred in not any case. JOA score was rated as good or excellent in 83.3% of the TLIF cases and in 81.7% of the PLIF cases. There were no difference between the two groups（P 〉0. 05 ）. Postoperative slippage rate was significantly less than preoperative ones in both groups （ P 〈0.01 ）. No difference in lost of reduction at the final follow-up was found between TLIF and PLIF groups （ P 〉0.05 ）. Significant increases in the height of intervertebral space and intervertebral foramen after operation were approved in both groups（ P 〈0.01 ）, but no difference in these increases was confirmed between the two groups （P 〉 0. 05）. The losts of the height of intervertebral space and intervertebral foramen at the final follow-up were also similar between the two groups （ P 〉 0. 05 ）. Conclusions TLIF and PLIF are good methods for the treatment of spondylolisthesis, both leading to satisfactory clinical outcomes. However, TLIF is relatively safer owing to its unilateral approach for interbody fusion.