前路腰椎间融合与经椎间孔腰椎间融合治疗退行性腰椎滑脱症的对比研究

Comparative study on anterior lumbar interbody fusion and transforaminal lumbar interbody fusion in treating spondylolisthesis

目的比较前路腰椎间融合（ALIF）和经椎间孔腰椎间融合（TLIF）治疗退行性腰椎滑脱症的临床疗效。方法回顾性分析2006年2月-2010年7月,该院收治的退行性腰椎滑脱症患者88例,分别采用ALIF治疗（A组）和TLIF治疗（B组）。其中A组46例,平均年龄55岁（48-65岁）;B组42例,平均年龄56岁（47-67岁）。两组患者一般资料差异无统计学意义,具有可比性。比较两组患者围手术期出血量、手术时间、术后腿痛和腰痛的视觉模拟评分（VAS）、腰椎滑脱改善程度、椎间高度的恢复以及椎间融合率。结果术后随访2-6年,平均3.5年。A组手术（170±45）min,B组（125±44）min（P〈0.05）;A组失血量为（1500±450）mL,B组为（995±405）mL（P〈0.05）;两组患者腿痛和腰痛较术前均有显著的改善（两者的腿痛改善率均为89%;A组和B组的腰痛改善率分别为78%和81%）;两组腰椎滑脱改善程度、椎间高度的恢复以及椎间融合率均相似。但是B组患者开始活动时间较早,住院时间较短（分别为7 d和12 d）。结论 ALIF和TLIF治疗退行性腰椎滑脱症均能取得良好的临床疗效,但是TLIF创伤较小,具有较短的恢复时间和住院时间。

【Objective】 To compare the outcome of anterior lumbar interbody fusion（ALIF） and transforaminal lumbar interbody fusion（TLIF） in the treatment of spondylolisthesis. 【Methods】 From February2006 to July 2010, 88 patients with instability of lumbar spine were treated by ALIF（Group A） or TLIF（Group B）. The mean age of Group A（n =46） was 55 years（range, 48 - 65 years）, and that of Group B（n =44） was 56 years（range, 47 - 67 years）. The two treatment groups were comparable in aspect of general data.The clinical outcomes were measured using the blood loss,the operation time, the visual analog score for both leg pain and back pain, and the degree of reduction of spondylolisthesis, restoration of disc height, and presence of fusion were assessed. 【Results】 All of 88 patients were followed up for an average of 22 months（range, 15 to 36 months）. The mean operation time was（170 ± 45） min in Group A and（125 ± 44） min in Group B（P〈0.05）; The mean blood loss was（1 500 ± 450） mL in Group A and（995 ± 405） mL in Group B（P〈0.05）; Both exhibited statistically and clinically significant improvements in back pain（Group A, 78%;Group B, 81%）, and leg pain（89% for both groups）. This was corroborated by improvements in social and physical functioning, which were similar for both groups. The reduction of spondylolisthesis and fusion rateswere also similar between the 2 groups. The patients in Group B commenced mobilization sooner, achieved independent mobilization earlier, and had a shorter hospital stay（7 d versus 12 d）. 【Conclusion】 There was no statistically significant difference in clinical results between ALIF and TLIF. They both reduce leg and back pain and restore function to a similar extent. But, TLIF takes advantages of less blood loss, less operative time and faster recovery and shortens hospital stay.