后路腰椎间融合与经椎间孔腰椎间融合治疗单纯腰椎不稳的对比研究

A comparative study on posterior lumbar interbody fusion and transforaminal lumbar interbody fusion treating instability of lumbar spine

[目的]对后路腰椎间融合(Posterior Lumbar Interbody Fusion,PLIF)及经椎间孔腰椎间融合(Transforami-nal Lumbar Interbody Fusion,TLIF)治疗单纯腰椎不稳的手术创伤、并发症及术后疗效进行比较。[方法]将2006年2月～2009年7月收治的单纯腰椎不稳患者采用随机数字表法将患者分为PLIF组(110例)、TLIF组(108例)。术前评估两组患者一般资料差异无统计学意义,具有可比性。分别对两组患者的手术创伤、术中并发症及功能恢复情况进行比较。[结果]术后随访时间14～36个月,平均21个月。手术时间:PLIF组为(125.6±45)min,TLIF组为(124.9±44)min(P>0.05);失血量:PLIF组为(1 000±450)ml,TLIF组为(995±405)ml(P>0.05);术中并发症:PLIF组为3例,TLIF组为0例(P<0.05);术后优良率:PLIF组为93.6%,TLIF组为94.4%(P>0.05);术后融合率:PLIF组为96.4%,TLIF组为98.1%(P>0.05);JOA评分:PLIF组为14.5,TLIF组为14.6(P>0.05)。[结论]应用PLIF和TLIF治疗单纯腰椎不稳的临床疗效相近,但是TLIF创伤较小,并发症较少。

[Objective]To compare the outcome of posterior lumbar interbody fusion（PLIF） and transforaminal lumbar interbody fusion（TLIF） in the treatment of instability of lumbar spine. [Methods]From February 2006 to July 2009,the patients with instability of lumbar spine were divided into PLIF group（n=110） and TLIF group（n=108） randomly.The two treatment groups were comparable in aspect of general data.The clinical data of surgical trauma,complications and postoperative function of the two groups were compared in our study. [Results]All the 218 patients were followed up for an average of 21 months（range,14 to 36 months）.The mean operation time were（125.6±45） min in PLIF group and（124.9±44） min in TLIF group（P0.05）.The mean blood loss were（1 000±450） ml in PLIF group and（995±405） ml in TLIF group（P0.05）.The complications differed significantly,three cases in PLIF group compared with none in TLIF group（P0.05）.JOA score was rated as good-to-excellent in 93.6% of the PLIF cases and in 94.4% of the TLIF cases（P0.05）.Fusion rate of patients was 96.4% in PLIF and 98.1% in TLIF（P0.05）. [Conclusion]Instability of lumbar spine can be treated successfully with PLIF and TLIF.There is no significant difference in surgical trauma and functional outcome between the two groups.However,TLIF takes advantages of less blood loss,less operative time and less intraoperative complications over PLIF.