经后路椎弓根内固定椎间融合治疗老年腰椎滑脱临床疗效分析

The Analysis of Posterior Pedicle Screw Fixation and Interbody Fusion in the Treatment of Lumbar Spondylolisthesis in Elderly

目的:研究经后路椎弓根内固定椎间融合治疗老年腰椎滑脱的临床疗效。方法:选择2012年1月-2014年1月在笔者所在医院住院治疗的老年腰椎滑脱患者90例,采用随机数字表法将患者分为观察组和对照组,观察组予后路减压、椎体复位及椎间植骨融合手术,对照组在常规椎弓根内固定术基础上给予后外侧融合手术。所有患者随访12个月,比较两组患者的近远期疗效。结果:观察组平均手术时间长于对照组,平均术中出血量多于对照组,差异均有统计学意义(P<0.05)。随访患者1个月,两组患者术后滑脱百分率、椎间隙高度均明显低于治疗前,差异均有统计学意义(P<0.05);但两组术后滑脱百分率和椎间隙高度比较差异均无统计学意义(P>0.05)。从远期疗效看,随访1年,观察组患者滑脱百分率丢失、椎间隙高度丢失值均明显低于对照组,观察组融合率明显高于对照组,差异均有统计学意义(P<0.05)。结论:经后路椎弓根内固定椎间融合治疗老年腰椎滑脱可有效减压,脊柱融合率较高,显著改善患者临床症状。

Objective： To study the clinical efficacy of posterior pedicle screw fixation and interbody fusion in the treatment of elderly spondylolisthesis. Method： 90 cases with lumbar spondylolisthesis in our hospital from January 2012 to January 2014 were randomly divided into two groups, the observation group was given posterior decompression, vertebral reset and interbody fusion surgery.The control group received routine given posterolateral fusion surgery on the basis of pedicle screw fixation.All patients were followed up for 12 months, short-long-term efficacy of two groups were compared.Result： The mean operative time of the observation group was longer than that of the control group, the average blood was lower than that of the control group, the differences were statistically significant（P〈0.05）.Patients were followed up for 1 month, slip percentage and intervertebral height of two groups were significantly lower than before treatment, the differences were statistically significant（P〈0.05）.But the percentage of postoperative spondylolisthesis and intervertebral height of two groups, differences were not statistically significance（P〉0.05）.From the long-term effect, the follow-up one year later, slipping percentage loss and loss of disc height of the observation group were significantly less than those of the control group, the fusion rate was significantly higher, the differences were statistically significant（P〈0.05）.Conclusion： Posterior pedicle screw fixation and interbody fusion in the treatment of elderly spondylolisthesis is effective of decompression, spinal fusion rates higher and significantly improve the clinical symptoms, it is worthy of further application.