单节段与多节段融合治疗退行性腰椎滑脱疗效分析

Short- term Clinical Outcomes for Single- Versus Multilevel Interbody Fusion for Degenerative Spondylolisthesis

目的比较单节段固定椎间融合与多节段固定椎间融合联合选择性减压治疗多节段腰椎管狭窄症合并单节段退行性滑脱的近期临床疗效。方法回顾性研究2007—2011年于沈阳军区总医院骨科行手术治疗的207例多节段腰椎管狭窄症合并单节段退行性腰椎滑脱患者。分为单节段固定椎间融合选择性减压组（130例）和多节段固定椎间融合选择性减压组（77例）,分析两组术中失血量、手术时间、围手术期并发症,平均随访时间8-16个月。通过分析术后1周、3个月、6个月、1年患者功能障碍指数（ODI）,比较两种手术方式的近期临床疗效。结果两种手术方法术后1周、3个月、6个月、1年其ODI差异无统计学意义;但多节段椎间融合组的手术时间与出血量明显高于单节段椎间融合组,差异有统计学意义,P〈0.05。结论单节段固定椎间融合选择性减压和多节段固定椎间融合选择性减压在治疗多节段腰椎管狭窄症合并单节段退行性腰椎滑脱的近期临床疗效无明显差别。

Objective To compare short - term results of selective decompression and single - level interbody fusion with selective decompression and multilevel interbody fusion for patients with muhilevel lumbar stenosis and single - level degenerative spondylolisthesis （DS）. Methods We retrospectively studied 227 cases with muhilevel lumbar stenosis and single - level degenerative spondylolisthesis, they were divided into two groups ： single - level interbody fusion with selective decompression group and multilevel interbody fusion group. The intraoperative blood loss, operative time and perioperative complications of two groups of patients who were followed -up for 8 to 16 months were analyzed. Meanwhile,oswestry disability index of postoperative 1 week,3 months,6 months and 1 year were analyzed to evaluate two methods. Results 227 cases were followed up with an average of 12 months. 130 cases were performed selective decompression with 1 level interbody fusion and 77 cases with selective decompression and multilevel interbody fusion. For all primary outcome measures, there were no statistically significant differences in surgical outcomes between the two surgical techniques. However,operative time and intraoperative blood loss were significantly higher in the multilevel fusion group. Conclusion Selective decompression with single -level interbody fusion and selective decompression with muhilevel fusion provide similar short - term outcomes fro patients with multilevel lumbar stenosis and single - level degenerative spondylolisthesis.