后外侧植骨与椎间植骨融合术治疗腰椎滑脱症的远期疗效比较

Comparison of long-term efficacy between posterior lateral fusion and interbody fusion in treatment of patients with lumbar spondylolisthesis

目的比较后外侧植骨与椎间植骨融合术治疗腰椎滑脱症的远期疗效。方法 116例腰椎滑脱症患者分为2组。A组行椎弓根钉内固定复位横突间植骨融合术,B组行椎弓根钉固定复位椎间融合术。比较2组的滑脱复位率、复位丢失率、椎间隙高度丢失率、植骨融合率、手术疗效和并发症。结果 2组手术前后及随访时滑脱率、复位率比较,差异有统计学意义(P<0.05)。B组融合率显著高于A组(P<0.05)。2组手术前后及随访时的椎间隙高度与近心端第2椎间隙高度比值有显著差异(P<0.05)。2组JOA评分、RIS及优良率比较无显著差异(P>0.05)。2组术前及随访时下腰痛和下肢痛VAS评分比较无显著差异(P>0.05)。A组并发症发生率为21.6%,显著高于B组的10.7%(P<0.05)。结论与后外侧植骨相比,椎间融合术能够维持滑脱的矫正,减少术后远期并发症的出现,但两种术式的效果无显著差异。

Objective To compare the long-term efficacy of posterior lateral fusion and interbody fusion in the treatment of patients with lumbar spondylolisthesis. Methods A total of 116 patients with lumbar spondylolisthesis were divided into two groups. Group A was treated with posterior fixation and posterior lateral bone graft fusion,group B was treated with posterior fixation and interbody fusion. The reduction rate,the loss rate,the height loss rate of intervertebral space,the fusion rate of bone graft,the effect of operation and complications were compared between two groups. Results There were significant differences of slip ratio and reduction rate at time points of before treatment,after operation and follow up between the two groups（ P〈0. 05）. The fusion rate of group B was significantly higher than that of group A（ P〈0. 05）. There was significant difference in ratio between the height of the intervertebral space and the height of the second intervertebral space in the proximal end of the heart at the time points of before treatment,after operation and follow-up between two groups（ P〉0. 05）. There were no significant differences in JOA score,RIS and good rate between the two groups（ P〈0. 05）. There were no significant differences in VAS scores of preoperative and postoperative low back pain and lower limb pain between two groups（ P〈0. 05）. The incidence rate of complications in group A was 21. 6%,which was significantly higher than 10. 7% in group B（ P〉0. 05）. Conclusion Compared with the posterior lateral bone graft,interbody fusion can maintain the correction of spondylolisthesis and reduce the incidence of postoperative complications,but there is no significant difference between the two types of surgery.