不同植骨方式应用于退行性腰椎滑脱症后路手术的疗效分析

Clinical Outcomes of Deferent Fusion Methods for Degenerative Lumbar Spondylolisthesis

为了比较后路椎间植骨融合(posterior lumber interbody fusion,PLIF)、后外侧植骨融合(posterolateral lumbar fusion,PLF)及二者联合运用(PLIF+PLF)在退行性腰椎滑脱症后路手术中的疗效,对59例退行性腰椎滑脱症患者根据手术中植骨方式分为三组,回顾三组患者的临床资料,比较三种植骨融合方式手术时间、术中出血量、椎间隙高度、滑脱角、植骨融合率以及JOA评分改善率。结果显示:B组(PLF)的植骨融合率低于A组(PLIF)及C组(PLIF+PLF)。在椎间隙高度维持、滑脱角丢失等方面A组优于B组(P<0.05),并且与C组无差异(P>0.05)。在手术时间及术中出血量方面A组优于C组(P<0.05),并且与B组无差异(P>0.05)。JOA评分改善率比较,三组间无显著性差异(P>0.05)。因此,得出结论:PLIF和PLF均是退行性腰椎滑脱症后路手术中的有效融合方式;PLIF及PLIF+PLF的融合率优于PLF;综合分析PLIF应用于退行性腰椎滑脱症后路手术中优于PLF及PLIF+PLF。

To compare the clinical outcomes of posterior lumber interbody fusion （PLIF）, posterolateral lumbar fusion （PLF） and PLIF associated with PLF（PLIF＋PLF） for degenerative lumbar spondylolithesis. 59 patients were divided into three groups by the style of fusion. The three groups were compared for operating time, blood loss, fusion rate, disc space height,slipping angle and the rate of the improved JOA score（RIS）. The fusion rate of PLIF or PLIF-FPLF was higher than PLF（ P〈0. 05）. PLIF＋PLF had more operating time and blood loss than PLIF or PLF （P〈0.05）. PLF were worse than PLIF or PLIF＋PLF for the disc space height and the slipping angle（P〈0. 05）. No statistical differences were found for the rate of the improved JOA score （RIS） of the three groups（P〉0.05）. Therefore, PLIF and PLF were both valid bone graft methods for degenerative lumbar spondylolithesis. The fusion rate of PLIF and PLIF＋PLF were higher than PLF. Generally,PLIF was better than PLF or PLIF＋PLF for degenerative lumbar spondylolisthesis.