不同部位植骨融合方式对腰椎滑脱症的疗效比较分析

A Comparative Study of Bone Fusion for Lumbar Spondylolisthesis by Three Methods

目的探讨不同的植骨部位融合方式对腰椎滑脱的治疗效果差异。方法选取2007年1月至2012年1月重庆市九龙坡区第二人民医院骨科收治的腰椎滑脱患者99例,采用完全随机化进行分组:A组33例,采用经椎管椎体间植骨融合术;B组33例,采用经关节突椎间椎板植骨融合术;C组33例,采用经关节突、横突间椎板植入融合术,比较三组的临床疗效。术后对患者随访7个月至3年,进行JOA评分。结果所有患者均顺利完成手术,无死亡病例。术中一般情况比较,A、B组的手术时间较C组更短,出血量也较C组的更少,差异有统计学意义(P<0.05),而两两比较发现A组与B组之间差异无显著统计学意义(P>0.05)。A、B、C滑脱复位率分别为93.41%、91.54%、92.49%,统计学比较P>0.05,无明显区别。A组优良率为75.76%,B组优良率为81.81%,C组优良率为78.79%。组间的优良率比较差异无统计学意义(P>0.05)。结论对于腰椎滑脱应根据滑脱程度、临床表现来选择相应的手术方式。

Objective To explore the effect of different types of surgical and bone graft procedures for lumbar spondylolisthesis. Methods According to three different fusion methods, 99 patients with lumbar spondylolisthesis from Jiulongpo Second People＇s Hospital during Jan. 2007 and Jan. 2012 were divided into 3 groups randomly： group A （intraspinal vertebral body fusion, n = 33 ）;group B （intervertebral body and vertebral lamina fusion through the zygapophyses, n = 33 ） ; group C （ the intervertebral body, transverse and vertebral lamina fusion through the zygapophyses, n = 33 ）. The therapeutic effect of the three groups was compared. Follow-up of seven months to three years was done after surgery, JOA was scored. Results All cases completed operation successfully, no death case happened. Operation time and blood loss in group C were higher than group A and B （ P 〈 0.05 ）, while the difference between group A and group B was not statistically significant（ P 〉 0.05 ） ;the reduction rate of spondylolisthesis of the 3 groups were 93.41%, 91.54% ,92.49 %, which were not statistically significantly different （ P 〉 0.05 ）. The patients were followed up for 7 months to 5 years,ande the good rate of group A ,B and C were 75.76% ,81.81% ,78.79% ,which were not statistically significantly different （ P 〉 0.05 ）. Conclusion Appropriate surgery method for lumbar spondylolisthesis should be selected according to spondylolisthesis extent and the clinical manifestations.