PLIF与PLF技术治疗腰椎滑脱症的疗效比较

A comparative study of posterior lumbar interbody fusion versus posterior lateral fusion in surgical treatment of isthmic spondylolisthesis

目的回顾性比较后路椎间融合术(PLIF)和椎体后外侧融合术(PLF)治疗腰椎滑脱症的临床疗效。方法自2007-06—2013-02在后路减压复位、椎弓根系统内固定的基础上行融合术治疗腰椎滑脱症42例:PLIF组13例,PLF组29例。结果术后所有滑脱椎体均获得不同程度的复位。PLIF组与PLF组术中平均出血量分别为(816.6±69.3)ml、(355.2±45.8)ml;2组术后椎间隙后高均较术前增加(P<0.05),而末次随访PLIF组椎间后高优于PLF组(P<0.05)。PLIF组术后翻修1例,余均获得融合,融合率92.3%,术中硬脊膜撕裂2例,未遗留神经症状;PLF组术后26例获得融合,融合率为89.7%,3例融合失败,随访椎间隙高度丢失,出现腰臀部疼痛复发,该组未出现神经损伤。术后PLIF组与PLF组ODI评分均较术前明显改善(P<0.05)。结论 PLIF与PLF技术均为治疗腰椎滑脱症有效的融合方式,前者具有良好的椎间撑开作用,适合术前椎间高度丢失较多的患者;而后者手术出血少、术中并发症少,较适合体弱、高龄、椎间高度丢失不显著的患者。

Objective To retrospectively compare the therapeutic effects of posterior lumbar interbody fusion and posteriorlateral fusion in the treatment of isthmic spondylolisthesis. Methods Between June 2007 and February 2013, 42 patientswith isthmic spondylol/sthesis were treated with posterior lumbar interbody fusion （PLIF group） or posterior lateral fusion（PLFgroup） after decompressive laminectomy and pedicle screw instrumentation. The blood loss, posterior height of intervertebraldisc and bone formation in different follow-up periods were compared and measured. The Oswestry Disability Questionnairewas used to evaluate the clinical outcomes. Results Postoperatively, the slipping degree reduced. The Oswestry DisabilityIndexes were significantly lower after operation in both groups （P 〈0.05）, but the blood loss and disc space height in the PLFgroup were less than in the PLIF group （P 〈0.05）. The post-operative fusion rate in the PLIF group was 92.3% and 89.7% inthe PLF group respectively, and no significant difference between the two groups, 2 patients in the PLIF group had durallaceration and no neurological deficits were found in the two groups. The failure of fusion was found in 3 cases in the PLFgroup and one case in the PLIF group. Conclusion To treat isthmic spondylolisthesis, PLIF and PLF could both achievesatisfactory spinal fusion. However the former has advantages of disc space height retoration, and is fit for patients with narrowintervertebral disc, the latter is more appropriate for the frail, old patients with slightly disc space height loss.