二椎体与三椎体复位固定治疗峡部裂性L5/S1滑脱症的近期疗效对比

Comparison of the short-term effectiveness of two-segment and three-segment reduction-fixation in treatment of L5/S1 isthmic spondylolisthesis

目的比较二椎体与三椎体复位固定治疗峡部裂性L5/S1滑脱症的近期疗效。方法回顾性分析本科2015年2月~2018年2月行腰后路减压、椎间植骨融合内固定术(PLIF)治疗的峡部裂性L5/S1滑脱症患者67例,其中二椎体固定组36例,三椎体固定组31例。比较两组患者的手术时间、术中出血量及术中C臂透视次数;采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评价患者的生活质量;测量术前及末次随访时腰椎-骨盆矢状面参数,包括腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、骨盆投射角(PI)和滑脱距离(SD),并计算滑脱率(SP)和滑脱复位率(RR)。结果三椎体固定组手术时间、术中出血量及术中C臂透视次数均明显大于二椎体固定组(P<0.05)。二椎体固定组随访时间(11.17±6.11)个月,三椎体固定组随访时间(12.19±7.01)个月,差异无统计学意义(P>0.05)。末次随访时,两组患者VAS评分及ODI评分均较术前明显改善,三椎体固定组VAS评分及ODI评分改良率优于二椎体固定组,差异具有统计学意义(P<0.05)。末次随访时,三椎体固定组术后滑脱复位率高于二椎体固定组,且腰椎-骨盆矢状面参数LL、SS及PT矫正率同样高于二椎体固定组,差异具有统计学意义(P<0.05)。二椎体固定组和三椎体固定组分别有6例、9例发生并发症,差异无统计学意义(χ^2=1.466,P=0.226)。结论二椎体与三椎体复位固定治疗峡部裂性L5/S1滑脱症均能取得满意的临床疗效;三椎体复位固定更有利于滑脱椎体的复位及腰椎-骨盆矢状面参数的改善,但手术时间长,创伤大。

Objective To compare the short-term effectiveness of posterior lumbar interbody fusion(PLIF) in treatment of L5/S1 isthmic spondylolisthesis(IS) with two-segment or three-segment reduction-fixation.Methods A total of 67 patients with L5/S1 IS who received PLIF from February 2015 to February 2018 were retrospectively reviewed.There were36 cases in the two-segment reduction-fixation group and 31 cases in the three-segment reduction-fixation group.The operation time,intraoperative blood loss and C-arm fluoroscopy times were compared between the two groups.The visual analogue scale(VAS) score and Oswestry disability index(ODI) were used to evaluate the perioperative pain and function.The lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI) and slip distance(SD)were recorded,and the slip percentage(SP) and reduction rate(RR) were calculated before surgery and at the final follow-up.Results The operation time,intraoperative blood loss and C-arm fluoroscopy times in the three-segment reduction-fixation group were higher than those in the two-segment reduction-fixation group(P<0.05).There was no differences in the follow-up time between the two groups [(11.17±6.11) vs.(12.19±7.01) months,P>0.05].At the final follow-up,both VAS and ODI in the two groups were significantly improved,and the improvement rate of VAS and ODI in the three-segment reduction-fixation group was significantly better than that in the two-segment reduction-fixation group(P<0.05).The RR,LL,SS and PT were higher in the three-segment reduction-fixation group than those in the two-segment reduction-fixation group(P<0.05).The complications in two groups were no significantly difference(6 vs.9 cases,χ2=1.466,P=0.226).Conclusion Two-segment and three-segment reduction-fixation are both effective in treatment of L5/S1 isthmic spondylolisthesis.Three-segment reduction-fixation has advantages in spondylolisthesis reduction and lumbo-pelvic sagittal parameters correction,however,with longer operation time and greater surgical trauma.