后路腰椎椎间融合术中置入单枚或双枚椎间融合器治疗Ⅱ度退行性腰椎滑脱症

Treatment of gradeⅡdegenerative lumbar spondylolisthesis with single or double cages in posterior lumbar interbody fusion

目的对比分析后路腰椎椎间融合术(PLIF)中置入单枚或双枚椎间融合器治疗Ⅱ度退行性腰椎滑脱症的临床疗效。方法2017年8月—2020年6月,山东省文登整骨医院采用单节段PLIF治疗Ⅱ度退行性腰椎滑脱症患者93例,其中47例术中置入单枚融合器(A组),46例置入双枚融合器(B组)。记录2组手术时间、术中出血量、并发症发生情况及翻修率,采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)评估疼痛程度及腰椎功能。在手术前后腰椎正侧位X线片及CT上测量滑脱位移距离、椎间隙高度,并记录滑脱完全复位例数和椎间隙高度丢失例数;观察椎间融合情况,并计算融合率。结果所有手术顺利完成,所有患者均获得1年以上随访。A组较B组手术时间短、术中出血量少,差异均有统计学意义(P<0.05)。2组术后各随访时间点VAS评分、JOA评分、ODI较术前明显改善,差异均有统计学意义(P<0.05),组间差异无统计学意义(P>0.05)。2组术后7 d、12周椎间隙高度及术后7 d滑脱完全复位例数差异无统计学意义(P>0.05);B组术后1年椎间隙高度、融合率、术后1年椎间隙高度丢失例数及翻修率均优于A组,差异有统计学意义(P<0.05)。2组早期并发症发生率差异无统计学意义(P>0.05);B组中远期并发症发生率低于A组,差异有统计学意义(P<0.05)。结论PLIF术中采用单、双枚椎间融合器治疗Ⅱ度退行性腰椎滑脱症,早期均可获得满意疗效。单枚融合器置入操作创伤小、手术时间短、术中出血量少,但远期随访易发生椎间隙高度丢失、内固定器松动断裂、邻椎病、融合器移位下沉等中远期并发症,导致融合失败及翻修率升高。

Objective To compare the clinical efficacy of posterior lumbar interbody fusion(PLIF)with single or double cages for the treatment of gradeⅡdegenerative lumbar spondylolisthesis.Methods From August 2017 to June 2020,93 patients with gradeⅡdegenerative lumbar spondylolisthesis were treated with single segment PLIF in Shandong Wengdeng Osteopathic Hospital,including 47 patients with single cage(group A)and 46 with double cages(group B).The operation time,intraoperative blood loss,complications and revision rate were recorded in the 2 groups.The pain intensity and lumbar function were evaluated by visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI).The slip displacement distance and the intervertebral space height were measured on roentgenographs and CTs before and after operation,and the cases of spondylolisthesis reduction and intervertebral space height loss were recorded;the intervertebral fusion was observed,and the fusion rate was calculated.Results All the operations were successfully completed.All the patients were followed up for more than 1 year.Compared with group B,group A had shorter operation time and less intraoperative blood loss,and the differences were statistically significant(P<0.05).The VAS score,JOA score and ODI of the 2 groups at each follow-up time point after operation were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05),but there was no significant difference between the 2 groups(P>0.05).There was no significant difference in the intervertebral space height at postoperative 7 d and 12 weeks and the cases of spondylolisthesis reduction at postoperative 7 d between the 2 groups(P>0.05);the intervertebral space height,fusion rate,cases of intervertebral space height loss and revision rates at postoperative 1 year in group B were better than those in group A,all with a statistical significance(P<0.05).There was no significant difference in the incidence of early complications between the 2 groups(P>0.05);the incidence of mid-and long-term complications in group B was lower than that in group A,with a statistical significance(P<0.05).Conclusions PLIF with single or double cages in the treatment of gradeⅡdegenerative lumbar spondylolisthesis can achieve satisfactory results in the early stage.Single cage placement has less trauma,shorter operation time,and less intraoperative blood loss.However,in the long-term follow-up,there are mid-and long-term complications such as loss of intervertebral space height,internal fixation loosening and rupturing,adjacent vertebral diseases,cage displacement and subsidence,resulting in fusion failure and higher revision rate.