椎间撑开解剖复位对于退变性腰椎滑脱症价值的前瞻性比较研究

Prospective comparison research of intervertebral disc space distraction and anatomical reduction of instrumented posterior lumbar interbody fusion for lumbar degenerative spondylolisthesis

目的：通过前瞻性研究评价椎间撑开解剖复位对于退变性腰椎滑脱症价值。方法：2006年1月-2009年12月,对56例退变性腰椎滑脱症（II度以上）患者均施行经后路椎体间融合术（poster ior lumbar interbody fusion,PLIF）,但随机选择是否在术中进行解剖复位的操作,复位组30例,对照组26例,随访时比较两组病例的影像学、JOA功能障碍评分及并发症。结果：56例均获得13-46个月（平均32月）随访。复位组的影像学结果及最终融合率均优于对照组（P〈0.01）。末次随访时,两组患者都有较高的JOA功能障碍评分,复位组略优于对照组（P〈0.01）。复位组和对照组的并发症发生率分别为10%和23.1%。结论：经后路椎体间融合术治疗退变性腰椎滑脱症术中进行解剖复位可以获得更为理想的影像学结果、植骨融合及生活质量。

Objective： To prospectively evaluate the special roles of anatomical reduction of instrumented posterior lumbar interbody fusion for lumbar degenerative spondylolisthesis. Methods： From January 2006 to December 2009,fifty-six lumbar degenerative spondylolisthesis cases were treated by instrumented posterior lumbar interbody fusion, all surgical cases were randomly divided into reduction group and matched group according to whether anatomical reduction. The definitive reduction of the spondylolisthesis using pedicle screw instrumentation was followed by primary reduction using intervertebral disc space distraction and interbody fusion with insert cages and local morselized bone after decompressive laminectomy. Main outcome measurements included imaging,JOA dysfunction score and complication. Results： Fifty-six patients were followed up for 13 to 46（average, 32）months, the Imaging results and solid bony fusion rate of reduction group were bett er than matched group（P〈0.01）.Both groups had preferable JOA dysfunction score. Reduction group was slightly bett er than matched group（P〈0.01）.The complication rates for reduction group and matched group were 10% and 23.1%, respectively. Conclusion：Instrumented posterior lumbar interbody fusion following by anatomical reduction for lumbar degenerative spondylolisthesis can obtained with more ideal Imaging results, solid bony fusion rate and the quality of life.