单双侧椎间隙松解治疗下腰椎滑脱的病例对照研究

Case control study of unilateral and bilateral intervertebral space release in the treatment of lower lumbar spondylolisthesis

目的:分析单双侧椎间隙松解治疗下腰椎滑脱的临床疗效。方法:回顾分析2012年10月至2016年5月手术治疗的41例腰椎滑脱症患者,其中单侧椎间隙松解组18例,男7例,女11例;年龄47～75(59.3±6.4)岁;Meyerding分级Ⅰ度9例,Ⅱ度7例,Ⅲ度2例。双侧椎间隙松解组23例,男11例,女12例;年龄51～76(58.2±5.7)岁;Meyerding分级Ⅰ度11例,Ⅱ10例,Ⅲ度2例。比较两组患者的手术时间、术中出血量、植骨融合率、手术前后疼痛视觉模拟评分(visual analogue scale,VAS)等临床指标。在X线和CT上测量滑脱率、滑脱角、椎间隙后缘高度、椎间孔高度、椎间孔顶点前后位移距离5项放射学参数,并进行组内和组间对比分析。结果:所有患者获得随访,时间9～24个月,平均12个月,41例患者在术后12个月均获得良好骨性融合。两组患者手术出血量、手术时间、术后12个月时患者的腰腿痛VAS评分差异无统计学意义(P>0.05)。所有患者的滑脱角、椎间隙后缘高度、椎间孔高度、椎间孔顶点前后位移距离手术前后比较差异有统计学意义(P<0.05);单侧组术后滑脱率与术前比较差异无统计学意义(P>0.05),而双侧组手术前后比较差异有统计学意义。术后滑脱角、椎间隙后缘高度、椎间孔顶点前后位移距离组间比较差异有统计学意义(P值分别为0.001、0.045、0.001)。两组患者术后椎间孔高度均较术前增高,滑脱率较术前减少,但组间差异无统计学意义(P=0.248)。结论:单双侧椎间隙松解治疗腰椎滑脱,都能明显减少滑脱率,恢复椎间孔高度,取得较好的临床疗效。双侧组能更好的恢复滑脱角,增加椎间隙后缘高度,减少椎间孔顶点前后位移距离。尤其对于Ⅱ度或者Ⅱ度以上滑脱更为合适。

Objective：To analyze the clinical efficacy of unilateral and bilateral intelvertebral space release in the treat- ment of lower lumbar spondylolisthesis. Methods ：The clinical data of 41 patients with lumbar spondylolisthesis treated by surgery from October 2012 and May 2016 were retrospcetive analyzed. The patients were divided into two groups, 18 cases were enrolled in unilateral intervertebral release group, there were 7 males and 11 females, aged from 47 to 75 years old with an average of （59.3±6.4） years;according to Meyerding classification, 9 cases of Ⅰ degree, 7 cases of Ⅱ degree, 2 cases of Ⅲ degree. And 23 cases were bilateral release group, there were 11 males and 12 females, aged from 51 to 76 years old with an average of （58.2±5.7） years;according to Meyerding classification, 11 cases of I degree, 10 cases of Ⅱ degree, 2 cases of Ⅲ degree. The operation time,intraoperative blood loss, bone graft fusion rate of the patients were recorded in the patients. Pre- and post-oper- ative back and leg pain were evaluated by visual analogue scale （VAS） between two groups. The slip rate, slip angle, posterior height of intervertebral space,height of intervertebral foramen,distance of anterior and posterior displacement of vertex of intervertebral foramen were measured on X-ray and CT. And the above radiographic data were analyzed by intra-group or intergroup. Results：All the patients were followed up from 9 to 24 months with an average of 12 months. The entire 41 patient obtained bone fusion at 12 months after operation. There was no statistical significance in VAS at 12 months after operation, intraoperative blood loss and operation time between two groups （P〉0.05）. There were statistical significance in sliding angle, posterior height of intervertebral space, height of intervertebral foramen, distance of anterior and posterior displacement of vertex of intervertebral foramen of all patients before and after operation（P〈0.05 ）. There was no statistical significance in spondy lolisthesis rate in unilateral release group between pre- and post-operative （P〉0.05）, but there was significant difference in bilateral release group. There was statistical significance in postoperative slip angle, posterior height of intervertebral space, distance of anterior and posterior displacement of vertex of intervertebral foramen between two groups （P=0.001,0.045,0.001）. The height of intervertebral foramen increased and the slippage rate decreased in both groups after operation,but there was no significant difference between two groups （P=0.248）. Conclusion：Unilateral and bilateral intervertebral space release for the treatment of lumbar spondylolisthesis can obviously reduce the rate of spondylolisthesis,restore foraminal height and achieve better clinical efficacy. Bilateral release group can better restore the slip angle, increase posterior height of intervertebral space, reduce the distance of anterior and posterior displacement of vertex of intervertebral foramen. Especially for grade Ⅱ or above degree of slippage is more appropriate.