PLIF和PLF在下腰椎单节段腰椎滑脱中的治疗疗效比较

Comparison of Clinical Outcomes of Posterior Lumbar Interbody Flusion and Posterolateral Fusion in the Treatment of Low Degree Spondylolisthesis

目的:观察和比较两种不同的融合术式PLIF(posterior lumbar interbody fusion)和PLF(postero1ateral fusion)在下腰椎单节段腰椎滑脱中的治疗疗效。方法:我们采用回顾性分析的方法,对于2013年1月到2016年1月在我院诊断为腰椎滑脱症并行腰椎融合外科手术的患者进行观察和分析。经纳入及排除标准筛选后,共有142名患者纳入本研究。根据融合手术术式的不同,分为PLIF组(82人)和PLF组(60人)。对于两组患者在术前与术后3月、12月的疼痛评分,功能障碍程度指数(JOA),出血量、手术时间、并发症等指标进行记录和比较。结果:纳入本课题的患者均接受了至少1年的连续全面的随访。两组患者在术后(1月及12月)的VAS疼痛评分均显著优于术前。但PLIF组在术后12个月时的VAS评分及融合率显著优于PLF组。在手术时间,出血量,花费、并发症等指标中,PLF优于PLIF组。两组在住院时间,卧床时间,JOA评分等指标的比较中并无显著性差异。结论:对于单节段的下腰椎滑脱患者来讲,使用PLIF能够取得较好的症状改善,融合率较高。但PLF同样具有其独特的优势。在临床工作中应该个性化的进行手术术式的选择。

Objective： To compare the clinical outcomes and radiological results of posterior lumbar interbody fusion （PLIF） and posterolateral fusion （PLF） in the treatment of low degree spondylolisthesis. Methods： 142 patients who were admitted in our hospital from 2013.01 to 2016.01 and diagnosed as spondylolisthesis were were retrospectively analyzed. All the patients who were divided into posterior lumbar interbody fusion group （PLIF） and posterolateral fusion group （PLF） were evaluated by visual analogue scale （VAS）, X ray or MRI, JOA, fusion rate, the average amount of bleeding, operation time and the incidence of complications. Results： All patients were followed up at least 1 years after the operation. The results of postoperative （1 and 12 months after the operation） VAS score were obviously improved compared with preoperative evaluation （P〈0.05）. The VAS score and fusion rate of PLIF were significantly better than that in PLF in the 12th month. The average amount of bleeding, operation time and the incidence of complications for PLF group were better than PLIF group＇s （P〈0.05）. There was no difference between two groups in the the average days of hospitalization, stay time and JOA. Conclusion： Clinical and radiological outcomes of PLIF group is superior than PLF group＇s for low degree spondylolisthesis. Howerer, results of PLF group is also objective, so we think that it need to be individual to design the surgical method for some special person on clinic.