两种术式治疗退变性腰椎滑脱的疗效比较

Comparison effect of two methods for treatment of degenerative lumbar spondylolisthesis

目的比较椎间孔腰椎间融合术(TLIF)联合对侧椎板开窗减压和后路腰椎间融合术(PLIF)治疗退变性腰椎滑脱(DLS)的临床疗效。方法将156例DLS患者根据手术方式不同分为TLIF开窗组(采用TLIF联合对侧椎板开窗减压治疗,75例)和PLIF组(采用PLIF治疗,81例)。比较两组围手术期资料、影像学资料。采用术后腰、腿痛VAS评分及ODI评价生活质量。结果患者均获得随访,时间24~67(32.3±11.5)个月。手术时间、术中出血量、术后引流量:TLIF开窗组均明显短(少)于PLIF组(P<0.01)。末次随访时椎间隙高度、腰椎前凸角、滑脱率、ODI及腰、腿痛VAS评分:两组均较术前明显改善(P<0.01);两组间比较差异均无统计学意义(P>0.05)。结论TLIF联合对侧椎板开窗减压和PLIF均是治疗DLS的有效方法,但TLIF联合对侧椎板开窗减压具有手术时间短、术中出血量少、创伤小的优势,更利于患者术后早期康复。

Objective To compare the clinical efficacy of transforaminal lumbar interbody fusion(TLIF)combined with contralateral laminectomy and posterior lumbar interbody fusion(PLIF)in the treatment of degenerative lumbar spondylolisthesis(DLS).Methods According to the different surgical methods,the patients were divided into TLIF fenestration group(75 patients underwent TLIF combined with contralateral laminectomy)and PLIF group(81 patients underwent PLIF).The perioperative and imaging date of the two groups were compared.The quality of life was evaluated by VAS of lower back and leg,ODI.Results All patients were followed up for 24~67(32.3±11.5)months.The operation time,intraoperative bleeding volume and postoperative drainage volume:TLIF fenestration group was significantly shorter(less)better than those of PLIF group(P<0.01).At the last follow-up,the vertebral space height,lumbar lordosis angle,lumbar spondylolisthesis rate,ODI and VAS of waist and leg:they were significantly improved,compared with those before operation(P<0.01),there was no significant difference between the two groups(P>0.05).Conclusions TLIF combined with contralateral laminectomy and PLIF are both effective methods for the treatment of DLS,while TLIF combined with contralateral laminectomy have the advantages of less bleeding and less trauma,which are more conducive to the early rehabilitation of patients.