经骶骨钛网原位融合与经椎间孔融合治疗成人Ⅱ度腰椎滑脱疗效对比  

Transsacral cage fusion in situ with posterior decompression and fixation versus reduction and transforaminal lumbar interbody fusion with posterior fixation in treatment of Grade Ⅱ lumbar spondylolisthesis

作　　者：王哲[1] 吴清涛[1] 龚凯[2] 胡慧敏[1] 罗卓荆[1] 

机构地区：[1]第四军医大学西京医院脊柱外科 [2]成都军区成都总医院骨科

出　　处：《脊柱外科杂志》2011年第4期211-215,共5页Journal of Spinal Surgery

基　　金：科技部"十一五"国家支撑计划项目(2007BAI04B07);卫生公益性行业科研专项经费项目(201002018)

摘　　要：目的针对13例椎间隙塌陷合并骨质疏松的L5Ⅱ度滑脱患者采取后路减压经骶骨钛网原位融合固定治疗,并与后路减压复位内固定、经椎间孔融合(transforaminal lumbar interbody fusion,TLIF)的21例患者在临床和影像学预后等方面进行了对比研究。方法回顾性分析了共34例患者,其中13例接受后路减压经骶骨钛网原位融合术(A组),另外21例接受后路减压复位内固定、TLIF术式(B组)。采用Oswestry功能障碍指数(Oswestry disabilityindex,ODI)和腰腿痛视觉模拟量表(visual analog scale,VAS)评分来评价临床疗效。影像学评估参数包括滑移率,全腰椎前凸角和腰骶角。同时记录了术中相关资料,融合率及围术期并发症。结果 A组平均手术时间和出血量显著低于B组,所有患者术后背部和腿部疼痛均显着减轻,2组间比较差异无统计学意义(P>0.05)。两组患者术后腰骶角、腰椎前凸角、VAS评分和ODI差异无统计学意义(P>0.05)。2组患者椎体融合率分别为92.3%和95.2%,A组中2例硬膜撕裂,2例一过性的S1感觉异常,踇长伸肌肌力下降1例;B组患者中有2例患者术后出现固定部位疼痛,1例表浅感染,1例螺钉松动。结论对于存在椎间隙塌陷和/或骨质疏松患者,经骶骨钛网原位融合固定术式可成为TLIF术式外的另一选择。经骶骨钛网原位融合固定与TLIF手术相比较,虽然具有相对较高的神经系统并发症发生率,但在短期临床预后和影像学结果方面并无明显差异。Objective To compare the clinical and radiological outcomes of posterior decompression,fixation and transsacral fusion in treatment of 13 cases with L5 Grade Ⅱ isthmic spondylolisthesis associated with collapsed disc space and osteoporosis,and of posterior decompression,transforaminal lumbar interbody fusion（TLIF） and instrumental reduction in 21 patients.Methods Thirteen patients treated with posterior decompression and transsacral cage fusion（Group A） and 21 patients treated with posterior decompression,reduction and TLIF（Group B） were analyzed retrospectively.Oswestry disability index（ODI） and visual analog scale（VAS） scores of back and leg pain were used to evaluate clinical outcomes.Radiological parameters for assessment included the percentage of slippage,whole lumbar lordosis,and lumbosacral angle.Operative data,fusion rate,and perioperative complications were recorded as well.Results The mean operation time and blood loss in Group A were less than those in Group B.Both groups had good recovery from previous symptoms.The decrease in back and leg pain after surgery was significant within each group,though without much difference between the 2 groups（P〉0.05）.No significant difference was found in lumbosacral angle,whole lumbar lordosis,VAS score,and ODI between the 2 groups after surgery（P〉0.05）.The solid fusion rate was 92.3% in Group A and 95.2% in Group B.In Group A,dural tears were found in 2 cases,transient S1 paresthesia in 2 cases,and extensor hallucis longus muscle weakness in 1 case.In Group B,2 cases suffered from graft site pain,1 case had a superficial infection,and 1 case had screw loosening.Conclusion For patients with a collapsed disc space and poor bone quality,posterior in situ transsacral cage fusion may be used as an alternative to the TLIF procedure.The short-term clinical and radiological outcomes in the transsacral cage group are comparable with those in the TLIF group,although with a relatively higher neurological complication rate.

关 键 词：腰椎 脊椎滑脱 内固定器 骨移植 脊柱融合术 

分 类 号：R681.533[医药卫生—骨科学]