三种植骨融合术治疗退变性腰椎滑脱症的疗效分析

Analysis of the curative effects of 3 methods of bone fusion for degenerative lumbar spondylolisthesis

目的比较腰椎经椎间孔椎间植骨融合术(TLIF)、腰椎后路椎间植骨融合术(PLIF)及腰椎后外侧融合术(PLF)治疗退变性腰椎滑脱症的临床疗效差异。方法同顾性分析2003年1月至2010年1月收治且获得随访的120例腰椎滑脱患者,根据植骨方式不同分为A组(TLIF组,35例)、B组(PLIF组,40例)及C组(PLF组,45例),比较3种植骨融合术的Nakai评分、融合率、椎间隙高度、椎间孔面积等情况。结果 A、B及C 3组Nakai评分的优良率分别为88.57%、87.50%、88.89%,3组比较无显著性差异(P>0.05);A、B及C组融合率、分别为91.43%、92.50%、68.89%,3组融合率有显著性差异(P<0.05)。进一步比较A、B两组融合率与C组融合率有统计学差异(P<0.05),A组与B组无显著性差异(P>0.05);椎间隙高度及椎间孔面积3组比较,A、B两组均显著优于C组(P<0.05),A、B两组间无差异(P>0.05)。结论 3种方法均可用于退变性腰椎滑脱症,PLF在融合率方面逊色于TI.IF及PLIF,TLIF及PLIF对腰椎滑脱矫正、融合率、椎间高度维持、神经松解等方面较PLF有显著的优越性,建议作为退变性腰椎滑脱症优先考虑术式。

Objective To compare the therapeutic effects of transforaminal lumbar interbody fusion （TLIF）, posterior lumbar interbody fusion （PLIF） and posterolateral lumbar fusion （PLF） for degenerative lumbar spondylolisthesis. Methods From January 2003 to January 2010, the follow-up data of 120 patients of lumbar spondylolisthesis were retrospectively analysed. All patients were divided into 3 groups： group A （TLIF, 35 cases）, group B （PLIF, 40 cases） and group C （PLF, 45 cases） based on fusion method. Nakai scale, bone fusion rate, maintenance of disc height and intervertebral foramen area of different fusion methods were compared and analysed. Results Comparing the 3 groups of A, B and C, the excellence rates respectively were 88.57%, 87.50% and 88.89% without significant differences （P〉0.05）. The fusion rates respectively were 91.43%, 92.50% and 68.89% with significant differences （P〈0.05）. Further comparing the fusion rates of A, B with C, significant differences existed （P〈0.05）. No significant difference existed comparing A and B （P〉0.05）. Maintenance of disc height and intervertebral foramen area were compared in all the 3 groups, significant differences existed comparing A, B with C （P〈0.05）. No significant difference existed comparing A and B （P〉0.05）. Conclusions All 3 methods can be used to treat degenerative lumbar spondylolisthesis. The fusion rates of TLIF and PLIF are better than PLF. TLIF and PLIF have significant advantages in the correction of spondylolisthesis, fusion rate, maintenance of disc height, enlargement of intervertebral foramen area and so on. TLIF and PLIF should be given priority to in the treatment of degenerative lumbar spondylolisthesis..