腰椎后外侧融合术与腰椎后路椎体间融合术治疗腰椎椎间盘突出症的疗效观察

Analysis on the efficacy of posterolateral lumbar fusion and posterior lumbar interbody fusion for treatment of lumbar intervertebral disc protrusion

目的观察腰椎后外侧融合术(PLF)与腰椎后路椎体间融合术(PLIF)治疗腰椎椎间盘突出症的临床疗效。方法按照手术方式将105例腰椎间盘突出症患者进行分组,PLF组52例行PLF术治疗,PLIF组53例行PLIF术治疗,对比术后手术效果。结果两组在手术时间、术中出血量和住院时间方面比较,差异无统计学意义(P>0.05);PLIF组术后总有效率94.34%高于PLF组80.77%,差异有统计学意义(P<0.05);两组均能够提高椎间高度和增加节段角度,但PLIF组提高椎间高度和增加节段角度幅度明显高于PLF组,差异有高度统计学意义(P<0.01);PLIF组手术并发症发生率7.55%与PLF组15.38%比较,差异无统计学意义(P>0.05)。结论 PLIF术治疗椎间盘突出较大或节段不稳的腰椎间盘突出症患者效果确切,能够快速恢复腰椎前柱支撑功能和重建腰椎生理曲度,符合腰椎生物力学原理,在促进患者腰椎功能早期恢复和提高生存质量方面具有重要意义。

Objective To observe the clinical efficacy of posterolateral lumbar fusion （PLF） and posterior lumbar interbody fusion （PLIF） in treatment of lumbar intervertebral disc protrusion. Methods A total of 105 patients with lumbar inter- vertebral disc protrusion were divided into two groups according to the surgical procedures. 52 cases in the PLF group were treated by PLF and 53 cases in the PLIF group were treated by PLIF. The surgical effects were compared. Results The two groups had no difference in operation duration, intraoperative blood loss and hospital stay, and there was no significant difference （P〉0.05）. The total effective rate was 94.34% in PLIF group, higher than 80.77% in PLF group, and there was sifference between two groups （P〈0.05）. Both groups had increase of intervertebral height and segmental angle, but PLIF group had significantly greater increase of intervertebral height and segmental angle, and there was significant difference between two groups （P〈0.O1）. The surgical complication rate was 7.55% in PLIF group and 15.38% in PLF group, and there was significant difference （P〉O.05 ）. Conclusion PLIF has significant effects for treat- ment of lumbar intervertebral disc protrusion with greater protrusion or segmental instability. PLIF can promote fast re- covery of the supporting function of the anterior lumbar column and reconstruction of lumbar physiological curvature, which is consistent with lumbar biomechanical principles. PLIF has significant meaning in promoting early recovery of lumbar functions and improving life quality.