三种后路融合方式治疗腰椎滑脱的外科疗效评价

Comparison of three different posterior fusions for lumbar spondylolisthesis

目的比较后外侧融合、后路椎间融合与后路环形融合治疗腰椎滑脱的手术疗效,探讨其适应证。方法分别应用3种术式治疗不同类型及合并症的腰椎滑脱患者58例,比较手术时间、并发症、椎体滑脱矫正与复位丢失率、椎间隙高度以及下腰痛症状改善情况。结果三者均可以明显改善下腰痛;后外侧融合减少了术后一过性下肢麻痛的发生率但易出现植骨不融合及内固定失败;后路椎间融合及后路环形融合明显提高了植骨融合率,降低了假关节发生率和滑脱矫正度的丢失。结论3种后路融合术都是治疗腰椎滑脱的有效术式,退变性腰椎滑脱宜选用后外侧融合;峡部裂性腰椎滑脱宜选用后路椎间融合技术;Ⅱ度以上严重峡部裂性腰椎滑脱症或合并腰椎管狭窄需行广泛减压者宜选用后路环形融合。

Objective To compare the operative effect of the postlateral fusion （ PLF）, posterior interbody fusion （PLIF） and posterior circumferential fusion（PCF） for lumbar spondylolisthesis and explore its complications. Methods Fifty-eight consecutive patients with lumbar spondylolisthesis underwent different fusion procedure were divided into 3 groups： Group A, PLF; Group B, PLIF; Group C, PCF. Operation time, complications, spondylolisthesis reduction, reduction loss rate, disc space height and improvement of low back pain were compared among the 3 groups. Results All of the 3 fusion procedures improved the lumbar pain significantly. PLF reduced the occurrence of transient lower extremity paresthesia, but it was prone to bone graft nonunion and internal fixation failure. PLIF and PCF had a higher fusion rate and reduced the pseudarthrosis and reduction loss rate. Conclusion All of the 3 fusion procedures were efficient operation types for lumbar spondylolisthesis. PLF is fit for degenerative spoudylolisthesis, PLIF for spondylolysis, and PCF for severe spondylolysis with lumbar spinal stenosis or segment instability which needs complete laminectomy and decompression.