单纯后外侧融合术治疗腰椎滑脱的临床研究

Clinical results of posterolateral fusion in treating lumbar low-grade spondylolisthesis

目的 探讨轻度腰椎滑脱减压复位后单纯行后外侧融合（PLF）的临床疗效.方法 回顾性分析2001年10月至2008年7月收治的37例轻度腰椎滑脱行单纯PLF患者的临床资料.其中男性9例,女性28例;年龄27～88岁,平均60.1岁.术前和末次随访时采用视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分进行临床评价,融合及复位后丢失情况采用X线片及CT进行评价.结果 37例患者均获随访,随访时间14～96个月,平均36.4个月.术后滑脱复位率为76.4%,末次随访时34例（91.9%）出现复位丢失,平均丢失5.8%（-3.0%～25.8%）.术前、术后及末次随访的滑脱率比较差异均有统计学意义（P=0.000）;术后椎间盘高度与术前、末次随访之间差异有统计学意义（P＜0.05）;末次随访腰前凸角度与术前、术后之间差异有统计学意义（P＜0.05）;末次随访VAS和ODI评分与术前比较差异均有统计学意义（P=0.000）.X线片和CT评价融合率分别为91.9%和94.6%.并发症有出现退变性侧凸2例,术后14个月出现上方邻近节段后滑脱1例,术后24个月出现螺钉切割断裂1例,术后早期出现伤口感染行清创术1例.结论 轻度腰椎滑脱患者复位后行单纯PLF中期随访时普遍存在滑脱矫正少量丢失现象,但临床效果及融合率尚可.

Objective To analyze the clinical outcomes and losses of correction for posterolateral fusion on low-grade lumbar spondylolisthesis. Methods From October 2001 to July 2008, 37 patients with a mean age of 60. 1 years （ range, 27-88 years ） with low-grade lumbar spondylolisthesis treated with posterolateral fusion, including 9 males and 28 females, were reviewed retrospectively. The clinical outcomes were evaluated using the visual analogue scale （VAS） and Oswestry disability index （ODI）. The fusion status and loss of correction were assessed using plain radiographs and CT. Results All the 37 patients had got complete follow-up for 14-96 months （average 36. 4 months）; post-operative reduction rate was 76.4%, and 34 patients （91.9%） showed loss of correction with a mean loss rate 5. 8% （ range,-3.0%-25.8% ）. The percentage of slip of pre-operative, post-operative and final follow-up indicated significant difference（ P ＜ 0. 05 ）compared with each other; post-operative intervertebral disc height indicated significant difference in comparison with that of pre-operatively and at final follow-up（ P ＜ 0. 05 ）; lumbar lordosis angle at final follow-up showed significant difference when compared with that of pre-operatively and postoperatively （P ＜ 0. 05）; VAS and ODI at final follow-up indicated significant difference in contrast to that of pre-operative （P ＜ 0.05 ）. Upon final follow-up, the complications were found in 2 cases who presented degenerative scoliosis at 15 and 17 months after the surgery, in 1 case with cranial adjacent segment retrolisthesis at the 14 months after the surgery, in 1 case with cut-out and breakage of screws at the 24 months after the surgery, and in 1 case with postoperative infection which were cured after debridement. Conclusions For mid-term follow-up of low-grade lumbar spondylolisthesis, posterolateral fusion shows loss of correction in most cases, but presents good clinical outcome and fusion rate.