不同融合术式联合椎弓根钉治疗腰椎滑脱的临床观察

Clinical Observation of Posterior Interbody Fusion and Posterolateral Fusion with Pedicle Screw Fixation for Lumbar Spondylolisthesis

目的观察比较椎弓根器械复位固定后两种不同融合法椎体间融合(posterior interbody fusion,PLIF)与后外侧融合(posterolateral fusion,PLF)对峡部裂型腰椎滑脱的疗效。方法选取2006年5月至2008年5月我科收治的腰椎滑脱患者78例,男43例,女35例;年龄45～68岁,平均52岁。L4滑脱33例,L5滑脱45例;度滑脱12例,度滑脱66例。78例患者中行PLF结合椎弓根内固定治疗33例,行PLIF结合椎弓根内固定治疗45例,记录两组手术术中出血量及手术时间,对比分析两组患者即刻及随访2年后的X线影像学结果(包括滑脱矫正、滑脱节段椎间隙高度改变及植骨融合率)和临床疗效(JOA评分)。结果术后即刻X线影像学结果,包括滑脱矫正、滑脱节段椎间隙高度,两组间差异无统计学意义(P>0.05);术后2年随访时,在滑脱矫正及滑脱节段椎间隙高度的维持上PLIF组优于PLF组(P<0.05),骨融合率差异无统计学意义(P>0.05),两组间临床疗效(JOA评分)差异无统计学意义(P>0.05)。结论椎弓根器械复位固定并PLIF与PLF都是治疗度以内腰椎峡部裂型滑脱的有效方法,PLIF在对滑脱矫形的维持及结构的稳定上具有优越的力学性能,PLF后期易出现矫正丢失,但临床疗效不受明显影响。

Objective To compare the therapeutic effect of surgical approach that posterior interbody fusion,posterolateral fusion with pedicle screw fixation for adult spondylolisthesis.Methods From May 2006 to May 2008,78 patients with spondylolisthesis were analyzed,including 43 males and 35 females,aged 52 years（ranging 45～68 years）.There were 33cases in L4,45 in L5;12 cases of degree Ⅰ,66 of degree Ⅱ.A total of 33 patients were treated with pedicle screw fixation and PLF（group A）,45 with pedicle screw fixation and PLIF using cage（group B）.Blood loss,surgery duration were recorded.Two groups were compared for clinical outcome（JOA）,radiographic data（including correcttion of slippage,disc space height and fusion rate）.Results All 78 patients were followed up for 24 months.Blood loss,surgery duration had significant differences between two groups.At 24 months,maintaince of correcttion of slippage and disc space height in PLIF group was better than that of PLF group（P0.05）,the segmental lordosis and fusion rate in PLIF group was similar to PLF group（P0.05）.However,no statistics intergroup different was found in terms of outcome（JOA）（P0.05）.Conclusion Pedicle screw fixation with PLIF or PLF are both effective for low grade isthmic spondylolisthesis.PLIF with Pedicle screw fixation confers superior mechanics strength in correction and maintaince of spinal reconstruction,PLF with pedicle screw fixation had significant loss of reduction and high hardware failure rate,but the clinical outcome was no influence.