退行性腰椎滑脱症与峡部裂性腰椎滑脱症患者的手术疗效比较  

Comparison of the surgical results in the patients with degenerative spondylolisthesis and isthmic spondylolisthesis

作　　者：黄卫国[1,2] 海涌[3] 

机构地区：[1]北京大学民航临床医学院 [2]民航总医院骨科,100123 [3]首都医科大学附属北京朝阳医院骨科,100020

出　　处：《中国骨与关节杂志》2014年第6期460-465,共6页Chinese Journal of Bone and Joint

摘　　要：目的比较退行性腰椎滑脱症与峡部裂性腰椎滑脱症两组患者手术治疗的临床疗效、安全性、有效性和术后2年的融合率。方法 2005年1月至2011年6月,72例成人II、III度腰椎滑脱症患者接受腰椎后路椎间植骨融合术(posterior lumbar interbody fusion,PLIF)治疗的回顾性临床研究。以腰椎滑脱的病理学改变分为退行性腰椎滑脱症和峡部裂性腰椎滑脱症两组。其中退行性腰椎滑脱症48例,Meyerding分级均为II度滑脱;峡部裂性滑脱症24例,Meyerding分级II度10例、III度14例。所有患者均行减压、复位、椎弓根螺钉固定和植骨融合术。两组患者术前一般资料差异无统计学意义(P>0.05)。比较两组患者的手术时间、术中出血量、术后下地活动时间、术后平均住院日和平均年龄,并分别于术前1天、术后1个月和术后2年,采用疼痛视觉模拟评分(visual analogue scores,VAS)和日本骨科学会(japanese orthopaedic association,JOA)腰痛疾患疗效评分进行评价治疗效果。根据术后1年腰椎X线片和CT平扫+三维重建评价腰椎融合情况。结果峡部裂性腰椎滑脱症组平均年龄(48.6±6.9)岁,退行性腰椎滑脱症组(59.5±9.9)岁,退行性组术中出血量(343.3±62.4)ml、术后下地活动时间(5.3±2.7)天和术后平均住院日(8.6±2.4.)天分别小于峡部裂性组(383.8±50.7)ml、(7.5±2.5)天、(10.2±3.8)天,两组比较,差异均有统计学意义(P<0.01)。峡部裂组手术平均时间略长于退行性组,但差异无统计学意义(P>0.05)。术中两组各有1例硬膜撕裂,结果无差异。JOA评分:术前1天,两组差异无统计学意义(P>0.05);术后1个月,退行性组(24.19±1.21)大于峡部裂性组(22.83±1.68),差异有统计学意义(P<0.01);术后2年,退行性组(25.33±1.06)大于峡部裂性组(24.04±1.99),差异有统计学意义(P<0.01)。VAS评分:术前1天,两组差异无统计学意义(P>0.05);术后1个月,退行性组(1.77±0.78)小于峡部裂性组(3.00±1.02),�Objective To compare the clinical results in the surgical treatment of degenerative spondylolisthesis and isthmic spondylolisthesis, regarding the safety, curative effects and fusion rate at 2 years after the operation.Methods A retrospective study was performed on 72 adult patients with grade II-III spondylolisthesis who underwent posterior lumbar interbody fusion （ PLIF ） from January 2005 to June 2011. All the patients were divided into 2 groups based on the pathological changes of lumbar spondylolisthesis, including the degenerative spondylolisthesis group （n=48 ） and the isthmic spondylolisthesis group （n=24 ）. According to the Meyerding grading system for spondylolisthesis, there were 48 cases of grade II in the degenerative spondylolisthesis group and 10 cases of grade II and 14 cases of grade III in the isthmic spondylolisthesis group. All the patients underwent decompression, reduction, pedicle screw ifxation and spinal fusion. The differences in the preoperative general data between the 2 groups were not statistically significant （P〉0.05 ）. The operation time, intraoperative blood loss, postoperative ambulation time, postoperative average length of stay and average age were compared between the 2 groups. The curative outcomes were evaluated based on the Visual Analogue Scale （ VAS ） and Japanese Orthopedic Association （ JOA ） assessment criteria for back pain at 1 day before the surgery and 1 month and 2 years after the surgery. The lumbar fusion was observed by the X-ray and 3-dimensional reconstruction of CT scan at 1 year after the surgery.Results The average age of the isthmic spondylolisthesis group was （ 48.6±6.9 ） years old, who was younger than （ 59.5±9.9 ） years old of the degenerative spondylolisthesis group. The intraoperative blood loss, postoperative ambulation time and postoperative average length of stay were （ 343.3±62.4 ） ml, 5.3±2.7d and （ 8.6±2.4 ） d in the degenerative spondylolisthesis group, which were all less than （ 383.8±50.7 ）

关 键 词：椎间盘退行性变 脊椎滑脱 腰椎 脊柱融合术 腰椎峡部裂 

分 类 号：R687.3[医药卫生—骨科学]