PLF与TLIF治疗腰椎退行性侧凸的对照研究  

PLF versus TLIF in the treatment of degenerative lumbar scoliosis

作　　者：李方财[1] 陈其昕[1] 陈维善[1] 徐侃[1] 吴琼华[1] 陈刚[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2012年第12期1121-1126,共6页Chinese Journal of Orthopaedics

基　　金：浙江省医药卫生科学研究基金（2008A096）

摘　　要：目的比较腰椎后外侧融合术（posterolateral lumbar fusion，PLF）与经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion，TIJIF）治疗腰椎退行性侧凸的安全性及有效性。方法40例Cobb角为20°～60°的腰椎退行性侧凸患者随机分为两组，分别采用PLF与TLIF技术进行矫形。比较两组手术时间、术中出血量及术后末次随访的Cobb角恢复率、腰椎前凸角恢复率、脊柱冠状面平衡与矢状面平衡恢复率、SRS-22问卷及ODI评分。结果获得完整随访资料者37例，PLF组18例、TLIF组19例。手术时间分别为（187．8±63．5）min、（253．2±57．6）min，术中出血量分别为（1166．7±554．1）ml、（1673．7±922．4）ml，差异均有统计学意义。早期并发症发生率分别为11．1％和26．3％。两组侧凸Cobb角恢复率（分别为58.3％、63．1％）、冠状面平衡恢复率（分别为52．7％、48．0％）的差异无统计学意义，腰椎前凸角恢复率（分别为36．7％、62．5％）、矢状面平衡恢复率（分别为44．8％、64．1％）的差异有统计学意义。SRS-22评估中，TLIF组疼痛及对治疗的满意度优于PLF组。ODI评分两组差异无统计学意义。结论TLIF技术增加了手术创伤及并发症，但有利于改善腰椎前凸及脊柱矢状面平衡，对腰椎退行性侧凸患者有更好的临床疗效；对腰椎前凸及矢状面平衡良好的患者，PLF仍然是可选择的方法。Objective To compare the safety and efficacy of posterolateral lumbar fusion （PLF） and transforaminal lumbar interbody fusion （TLIF） in the treatment of degenerative lumbar scoliosis （DLS）. Methods Forty DLS patients with Cobb angles of 20 to 60 degrees were divided randomly into PLF and TLIF groups. Operative time, intraoperative blood loss, imaging results, and clinical outcomes were compared. Results Complete information was available in 37 patients, including 18 patients in the PLF group and 19 in the TLIF group. There were significant differences between two groups with regard to the operative time （P=0.002） and the intraoperative blood loss （P=0.048）. The incidence of early complications in the 2 groups was 11.1% and 26.3%. There was no significant difference in the recovery rates of the Cobb angle and the spinal coronal balance between two groups. However, the recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different between two groups （36.7% vs. 62.5% and 44.8% vs. 64.1%, respectively）. In various domains of SRS-22, the scores for pain and satisfaction with treatment in TLIF was better that those in PLF groups. There was no significant difference in ODI score between two groups. Conclusion TLIF helps to improve lumbar lordosis and sagittal balance, which leads to better clinical outcomes. For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively, PLF is still an option.

关 键 词：脊柱融合术 腰椎 脊柱侧凸 

分 类 号：R687.3[医药卫生—骨科学]