TLIF与PLIF治疗腰椎退变性疾病的疗效对比  

Comparative study of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in treatment of degenerative lumbar disease

作　　者：张国威[1,2] 林宏生[1,2] 吴昊[1,2] 李劼若[1,2] 李德彦[1,2] 熊廷亮[1,2] 纪志盛[1,2] 

机构地区：[1]暨南大学附属第一医院骨科 [2]暨南大学骨科研究所,广东广州510632

出　　处：《暨南大学学报（自然科学与医学版）》2012年第6期591-596,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：澳门科学技术发展基金(026/2010/A);广东省科技计划项目(2010-170-1)

摘　　要：目的:对比经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)与经后路椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗单节段腰椎退变性疾病的临床疗效。方法:收集我院行经单侧椎间孔椎体间融合术结合椎弓根钉系统(TLIF组)治疗腰椎退变性疾病21例,行单节段经后路椎体间融合术结合椎弓根钉系统(PLIF组)治疗腰椎退变性疾病50例,比较TLIF组与PLIF组手术时间、术中出血量、术后引流量、术后住院时间、并发症发生率及植骨融合率;比较两组内及组间术前及末次随访的汉化版oswestry功能障碍指数问卷调查表(Oswestry disability index questionnaire,ODI)、手术上邻节段活动度。结果:随访12～36个月,平均24个月。TLIF组平均手术时间、术中出血量、术后引流量、术后住院时间均少于PLIF组,差异有统计学差异(P<0.05)。末次随访两组ODI功能障碍指数均较术前降低,差异有统计学意义(P<0.05);术前及末次随访组间差异无统计学意义(P>0.05)。末次随访TLIF组手术上邻节段活动度较术前差异无统计学意义(P>0.05),PLIF组手术上邻节段活动度较术前增大,差异有统计学意义(P<0.05),术前组间差异无统计学意义(P>0.05),末次随访PLIF组手术上邻节段活动度较TLIF组增大,差异有统计学意义(P<0.05)。结论:TLIF和PLIF是治疗腰椎退变性疾病两种有效的手术方式,两者近期疗效满意;TLIF较PLIF术后住院时间、手术时间短,术中出血量、术后引流量少,并发症发生率低;TLIF较PLIF能更好保留脊柱后柱韧带复合体结构,减少手术上邻节段活动度。Aim：To compare clinical effect,Range of motion（ROM） of the instrumented and upper adjacent level and complications between transforaminal lumbar interbody fusion and posterior lumbar interbody fusion.Indications,advantages and disadvantages of transforaminal lumbar interbody fusion technique were also described.Methods： Patient selection consisted of those presenting with low back pain or radiculopathy who have failed in nonoperative management at least 6 months.All patients had evidence of degenerative disc disease with interbody height loss or evidence of instability.This is a retrospective review of 71 patients with degenerative lumbar disease who were treated with transforaminal lumbar interbody fusion（TLIF group） or posterior lumbar interbody fusion（PLIF group）.All of patients were followed up,the mean follow-up time was 24months（range,12 to 36 months）.The operating time,blood loss,postoperative drainage,postoperative hospital stay and complications of all cases were recorded.The function of lumbar was evaluated by Oswestry Disability Index（ODI）.Flexion-extension radiographs were taken separately and Range of motion（ROM） of the instrumented and upper adjacent level were measured.The operating time,blood loss,postoperative drainage and postoperative hospital stay between TLIF and PLIF group were compared.ODI and ROM of the instrumented upper adjacent level were compared between in the TLIF group and PLIF group pre-and post-operatively. Results： There were 21 patients in TLIF group and 50 patients in PLIF group.The operating time,blood loss,postoperative drainage and postoperative hospital stay in the TLIF group were significantly less than those in the group of PLIF（P〈0.05）.ODI of the final follow-up were significantly lower than preoperative in both groups（P〈0.05）.Between groups,however,there were no significant differences neither at preoperative or final follow-up（P〈0.05）.ROM of the upper adjacent level at the final follow-up in the group of TILF was similar

关 键 词：腰椎退变性疾病 经椎间孔椎间融合 经后路椎间融合 临床疗效 

分 类 号：R681.5[医药卫生—骨科学]