前路与后路Cage植骨加椎弓根钉内固定治疗腰椎滑脱症疗效比较  

Anterior versus posterior cage implantation for interbody fusion combined with posterior pedicle screw fixation in treating lumbar spondylolisthesis

作　　者：姚涛[1] 周业金[1] 徐宏森[1] 梅宝珊[1] 何高[1] 江渟[1] 田克超[1] 

机构地区：[1]安徽医科大学第三附属医院合肥市第一人民医院骨科,安徽合肥230061

出　　处：《临床骨科杂志》2009年第3期266-269,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨前路Cage植骨加椎弓根螺钉内固定与后路Cage植骨加椎弓根钉内固定治疗腰椎滑脱症两种术式的临床效果。方法43例患者按手术方式分为两组:前路Cage植骨加椎弓根钉内固定组(A组)17例,后路Cage植骨加椎弓根钉内固定组(B组)26例,对两组的手术时间、术中出血量、临床疗效(JOA评分)、X线融合率及并发症进行比较分析。结果A组的手术时间及术中出血量均明显多于B组(P<0.05),两组患者在临床疗效、融合率方面差异无显著性(P>0.05);A组术后未见硬膜囊、神经根及大血管损伤,无逆行性射精及阳痿的并发症;B组术后有5例发生硬膜损伤、脑脊液漏,7例出现神经根牵拉表现。结论两种手术都是治疗腰椎滑脱症的有效术式。前路手术较复杂、创伤较大,后路手术损伤硬膜囊及神经根的风险较高。Objective To compare the clinical outcomes of anterior and posterior interbody fusion cage implantation combined with posterior pediele screw system in treating lumbar spondylolisthesis. Methods This retrospective study analysis was performed for the outcome of 43 patients with single level spondylolisthesis. All the patients were divided randomly into two groups： anterior lumbar fusion cage combined with posterior pedicle screw system （group A） was performed in 17 patients, and posterior lumbar interbody fusion cage combined with posterior pedicle screw system （group B） was performed in 26 patients. The two groups were compared for operation duration,amount of bleeding, JOA scoring, fusion rate anti complication. Results Operation duration,amount of bleeding in group B were less than those of group 1 （ P 〈 0. 05 for both）. There was no significant difference between the two groups in the therapeutic effect （JOA score） and radiographic fusion rate（ P 〉0. 05 ）. There was no leakage of cerebrospinal fluid, great blood vessel injury,nerve injury, retrogression ejaculation and impotency in group A. There was 5 got leakage of eerebrospinal fluid and 7 got nerve root traction injury in group B. Conclusions Both the operations are effective for lumbar spondylolisthesis. Comparing with posterior approach, the disadvantages of anterior approach are more complicated and more tissue trauma. And posterior approach has more risk of spinal dura mater and nerve injury than anterior approach. The techuique used should conform to the type and extent of spondylolisthesis and the experience of operators.

关 键 词：腰椎滑脱 CAGE融合器 椎弓根固定 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]