两种椎间融合手术治疗腰椎退变性疾病术后神经功能恢复的临床对照研究

Nerve functional rehabilitation of patients with lumbar degeneration treated by posterior lumbar interbody fusion vs transforaminal lumbar interbody fusion

目的评估腰椎后路椎体间融合术(posterior lumbar interbody fusion,PLIF)及椎间孔入路腰椎融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退变性疾病术后神经功能恢复情况。方法回顾性分析2003年6月～2011年1月行PLIF及TLIF的249例腰椎退变性疾病患者,记录医源神经根性损伤发生率、日本骨科学会(Jap-anese Orthopedics Association,JOA)评分改善率、中华骨科学会脊柱学组腰背痛手术评分,比较2种术式在神经功能恢复方面的异同。结果医源神经根性损伤发生率PLIF高于TLIF,两者差异有统计学意义(P<0.05)。2组间手术优良率以及术后3个月、末次随访时JOA评分改善率差异无统计学意义(P>0.05)。结论 TLIF术中医源性神经损伤发生率明显低于PLIF,长期神经功能改善情况,二者并无差异。

Objective To compare the nerve functional rehabilitation of patients with lumbar degeneration treated by posterior lumbar interbody fusion（PLIF） vs.transforaminal lumbar interbody fusion（TLIF）.Methods A total of 249 patients with lumbar degeneration treated by PLIF or TLIF from June 2003 to January 2011 were analyzed retrospectively.Evaluation criterion including incidence rate of iatrogenic nerve root dysfunction（INRD）,improvement of Japanese Orthopedics Association（JOA） score,and low back pain operational criteria of Chinese Orthopedics Association（spine group） were record to compare the nerve functional rehabilitation after PLIF vs.TLIF.Results INRD happened more frequently after PLIF than after TLIF,and the difference was statistically significant（P0.05）.The JOA improvement rate of PLIF and TLIF showed no significant difference（P0.05）.The excellent and good rates of operation showed no significant difference between PLIF and TLIF（P0.05）.Conclusion Compared with TLIF,PLIF leads to more temporary neurological disturbance,but equally long-time satisfactory neurological improvement.