两种腰椎后路椎间融合方式治疗退变性腰椎滑脱的疗效比较

Efficacy comparison of two methods of posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis

目的比较椎板原位回植腰椎后路椎间融合术(PLIF)与全椎板切除PLIF治疗退变性腰椎滑脱(DLS)的疗效。方法将73例DLS患者按照手术方式不同分为椎板原位回植组(采用椎板原位回植PLIF治疗,38例)和全椎板切除组(采用全椎板切除PLIF治疗,35例)。比较两组术中出血量、手术时间、术后引流量、并发症发生情况及椎间融合、邻近节段退变、腰痛复发情况。采用疼痛VAS评分、JOA评分评价临床疗效。结果患者均获得随访,时间24~60(40.4±6.5)个月。术中出血量、手术时间、神经损伤率、硬膜囊损伤率、椎间融合率两组比较差异均无统计学意义(P>0.05)。术后引流量、邻近节段退变率、腰痛复发率椎板原位回植组均少(低)于全椎板切除组(P<0.05)。两组术后均无感染、切口血肿、肺栓塞等并发症发生,腰痛及神经痛症状均消失或明显缓解。椎板原位回植组35例回植椎板均完全愈合,2例单侧愈合,1例双侧未愈合。疼痛VAS评分、JOA评分:两组术后各时间段均明显优于术前(P<0.01);术后12个月、末次随访时椎板原位回植组均优于全椎板切除组(P<0.05)。结论与全椎板切除PLIF相比,椎板原位回植PLIF治疗DLS具有操作简单、显露清晰、神经减压彻底、腰痛复发率低、腰椎功能明显改善的优势。

Objective To compare the efficacy of posterior lumbar interbody fusion(PLIF)with in situ replantation of lamina and PLIF with total laminectomy for degenerative lumbar spondylolisthesis(DLS).Methods According to different surgical methods,the 73 patients with DLS were divided into in situ replantation of lamina group(PLIF with in situ replantation of lamina,38 cases)and total laminectomy group(PLIF with total laminectomy,35 cases).Two groups were compared in the intraoperative blood loss,operation time,postoperative drainage volume,occurrence of complications and intervertebral fusion,adjacent segment degeneration,recurrence of low back pain.The pain VAS,JOA score were used to evaluate the clinical efficacy.Results All patients were followed up for 24~60(40.4±6.5)months.There were no statistical differences in intraoperative blood loss,operation time,nerve injury rate,dural sac injury rate,intervertebral fusion rate between two groups(P>0.05).The drainage volume after operation,adjacent segment degenerative rate and recurrence rate of low back pain were less(lower)in the in situ replantation of lamina group than those in the total laminectomy group(P<0.05).Postoperative complications such as infection,incisional hematoma and pulmonary embolism were not observed in both groups,and the symptoms of low back pain and neuralgia disappeared or significantly relieved.In the in situ replantation of lamina group,35 cases of replanted lamina were completely healed,2 cases were unilateral healed,and 1 case was not bilateral healed.Pain VAS,JOA score:at various time periods,both groups were significantly better than those of before operation(P<0.01);the in situ replantation of lamina group was superior to the total laminectomy group at postoperative 12 months and last follow-up(P<0.05).Conclusions Compared with PLIF with total laminectomy,PLIF with in situ replantation of lamina in the treatment of DLS has the advantages of simple operation,clear exposure,complete nerve decompression,low recurrence of low back pain,and obvious improvement of lumbar function.