不同手术方法治疗老年退变性腰椎滑脱合并腰椎管狭窄症疗效的比较  

Posterior interbody fusion versus improved transforaminal lumbar interbody fusion in segmental spinal fixation for aged spondylolisthesis with lumbar spinal canal stenosis

作　　者：马超[1] 吴继彬[1] 赵猛[1] 戴维享[1] 吴德慧[1] 王兆红[1] 冯杰[1] 柳超[1] 赵庆华[2] 田纪伟[2] 

机构地区：[1]徐州市中心医院骨科,江苏省221009 [2]上海交通大学附属第一人民医院脊柱外科

出　　处：《中华医学杂志》2012年第9期620-623,共4页National Medical Journal of China

摘　　要：目的比较两种脊柱融合术治疗老年退变性腰椎滑脱合并腰椎管狭窄症的临床疗效。方法将2007年3月至2011年6月收治的老年退变性腰椎滑脱合并腰椎管狭窄症28例患者分为A、B两组。分别行椎管减压加后路椎弓根螺钉固定＋经后路椎体间融合（PLIF）（A组）和椎管减压＋后路椎弓根螺钉固定加改良的经椎间孔腰椎椎体间融合（TLIF）（B组）。A组13例，平均42．5岁。B组15例，平均3,6．1岁。两组滑脱主要部位为LS／S1，滑脱度为Ⅱ至Ⅲ度，术前均行MRI或CT检查，证实有侧隐窝狭窄、中央椎管狭窄。两组术前资料无显著差异。结果28例患者均达到良好的融合效果；实施PLIF患者，Prolo功能和症状评分分别为1．36和1．48；术前腰椎滑脱角为46．9％，术后恢复至14．6％。实施改良TLIF患者，Prolo功能和症状评分分别为1．75和1．63；术前腰椎滑脱角为45．2％，术后恢复至26．3％。结论治疗老年退变性腰椎滑脱症，应用腰椎后路椎弓根内固定系统可以获得牢固稳定，在保持腰椎术后功能恢复方面，改良TLIF优于PLIF，但临床结果差异不明显。Objective To assess the clinical and radiographic outcomes of posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade II/11I spondylolisthesis so as to address the suitability of a dynamic stabilization. Methods A total of 28 consecutive patients underwent posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade Ⅱ/Ⅲ spondylolisthesis. Among them, 13 patients underwent posterior interfacet fusion （PLIF） and pedicle screw fixation. And improved transforaminal lumbar interbody fusion （ITLIF） and placement of the same system were performed in 15 patients. Their clinical, economic, functional, and radiographic data were recorded both pre- and postoperatively. Results The average changes of economic and functional scores on the Prolo scale were 1.36 and 1.48 respectively. In patients with posterior interbody fusion; the average preoperative vertebral slippage was 46.9% （ range： 25% - 75% ） versus 14. 6% （ range： 15% - 25% ） postoperatively. In patients with ITLIF, the average changes in economic and functional scores were 1.75 and 1.63 respectively. And the average preoperative vertebral slippage was 45.2% （range： 28% -78% ） compared with 26. 3% （range： 14% -28% ） postoperatively. When two fusion techniques were compared, an overall superior reliability and resistance of systems was associated with the ITLIF procedure. But their clinical outcomes did not differ greatly （ P 〉 0. 05 ）. Conclusion The application of a segmental pedicle screw fixation is both feasible and efficacious.

关 键 词：腰椎 脊柱融合术 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]