两种椎间植骨融合术治疗单节段腰椎退行性病变的疗效观察

Comparison of surgical results between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion for single segment degenerative lumbar disease

[目的]对比后路椎体间植骨融合术（posterior lumbar interbody fusion，PLIF）与经椎间孔椎间植骨融合术（transforminal lumbar interbody fusion，TLIF）治疗单节段腰椎退行性病变的手术疗效。[方法]收集2009年3月～2011年10月期间于本科行单节段手术治疗的腰椎退行性病变患者资料，其中接受PLIF患者77例，接受TLIF患者59例。比较两种术式手术时间、术中出血量、术后引流量、住院天数、并发症及植骨融合率。采用视觉疼痛模拟评分（visual analogue scale，VAS）、JOA评分（Japanese Orthopaedic Association scores）、Oswestry功能障碍指数（Oswestry disability index，ODI）和改良MacNab标准对手术疗效进行评定。末次随访时通过测量手术邻近节段腰椎间水平位移和角位移评估腰椎稳定性变化。[结果]术后随访时间24～55个月，平均37．2个月。PLIF组术中出血量、术后引流量、并发症发生率均高于TILF组（P〈0．05），手术时间、住院天数及植骨融合率两组无显著性差异（P〉0．05）。末次随访时两组患者术后腰腿痛VAS评分、JOA评分、ODI指数较术前均明显改善（P〈0．01），组间比较无显著性差异（P〉0．05）。末次随访时按改良Macnab标准评定手术疗效优良率，两组之间无显著性差异（P〉0．05）。术后两组患者手术邻近节段均未出现腰椎失稳现象。[结论]PLIF与TILF手术均是治疗单节段腰椎退行性病变的有效方法，短期内对邻近节段稳定性干扰较小。但TLIF创伤小、出血少，并发症发生率低，值得临床推广使用。

[ Objective ] To compare the clinical effects of posterior lumbar interbody fusion （PLIF） and transforaminal lumbar interbody fusion （TILF） for single -segment degenerative lumbar disease, [ Methods] One -hundred- thirty -six patients with single segment degenerative lumbar disease who underwent interbody fusion surgery from March 2009 to October 2011 were included in this retrospective study. The patients were divided into PLIF （ n = 77 ） and TLIF （ n = 59） groups. Factors such as the operation time, amount of intraoperative bleeding, hospitalization, complications, and fusion rate were recorded and compared. Clinical outcomes were evaluated by using a visual analogue scale （ VAS ）, Japanese Orthopedic Association （ JOA ） scores, Oswestry Disability Index （ ODI）, and modified MacNab criteria. At the last follow - up visit, lumbar flexion - extension radiographs were taken to evaluate the instability of the adjacent level. [ Results ] After surgery, the patients were followed up for an average of 37.2 months （ range, 24 - 55 months） . The amount of intraoperative bleeding and rate of complications in the PLIF group were more than those in the TLIF group （ P 〈 0.05 ） . Observation factors such as the operation time, hospitalization, and fusion rate were similar between the two groups （ P 〉 0. 05 ） . After treatment, the VAS scores, JOA scores, and ODI in the two groups were significantly improved compared to preoperative data （P 〈 0. 01 ） . At the last follow- up, the instability of the adjacent level and modified MaeNab criteria were excellent, with no significant differences between the two groups （ P 〉 0. 05 ） . [ Conclusion] Both PLIF and TILF operations can provide satisfactory clinical efficacy in the treatment of single segment degenerative lumbar disease and maintain adjacent lumbar instability. However, TLIF may be a better minimally invasive method for the patients.