两种手术方式治疗峡部裂型腰椎滑脱症的对比研究  

COMPARATIVE STUDY ON TWO SURGICAL TREATMENT OF ISTHMIC SPONDYLOLISTHESIS

作　　者：张超[1,2] 孙天威[2] 田融[2] 贾宇涛[2] 徐天同[2] 申庆丰[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市人民医院脊柱外科

出　　处：《中国修复重建外科杂志》2015年第2期179-183,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较两种融合方式联合椎弓根内固定治疗峡部裂型腰椎滑脱症的疗效。方法回顾分析2009年2月-2012年5月收治并符合选择标准的98例峡部裂型腰椎滑脱症患者临床资料,其中53例行腰椎后路椎板减压椎间盘切除椎间Cage植骨融合内固定术（A组）,45例行腰椎后路椎板减压后外侧植骨融合内固定术（B组）。两组患者性别、年龄、病程、滑脱节段及程度等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。比较两组手术时间、术中出血量、并发症、滑脱复位率及复位丢失率、植骨融合率、椎间隙高度、日本骨科协会（JOA）评分及改善率。结果 A组手术时间及术中出血量较B组显著增加（P〈0.05）。术中A组4例、B组1例发生硬脊膜撕裂;术后A组6例出现下肢根性症状;两组各出现1例切口感染。A组患者获随访24-36个月,B组26-40个月。术前及术后2周两组间JOA评分比较,差异均无统计学意义（P〉0.05）;2年时A组JOA评分及改善率显著优于B组（P〈0.05）。X线片复查示,A组术后2周滑脱复位率显著高于B组,术后2年复位丢失率显著低于B组;术后2周及2年,A组融合节段椎间隙高度均高于B组;术后2年,A组植骨融合率明显高于B组;以上各指标比较,差异均有统计学意义（P〈0.05）。结论与后外侧融合相比,后路椎体间融合能更大程度复位椎体,恢复腰椎曲度及椎间隙高度,植骨融合率较高,更大程度上恢复脊柱的力学稳定性,获得更好远期疗效。Objective To compare the effectiveness of treatment of isthmic spondylolisthesis between two different fusion surgeries combined with pedicle screw fixation system. Methods A retrospectively analysis was made on the clinical data of 98 patients with lumbar isthmic spondylolisthesis treated between February 2009 and May 2012. Of 98 cases, 53 underwent posterior lumbar interbody fusion（PLIF） combined with internal fixation（group A）, and 45 underwent posterolateral fusion（PLF） with internal fixation（group B）. There was no significant difference in gender, age, disease duration, segmental lesions, and degree of spondylolisthesis between 2 groups（P〉0.05）. The operation time, intraoperative blood loss, reduction rate of spondylolisthesis, reduction loss rate, fusion rate, intervertebral space height, Japanese Orthopedic Association（JOA） score, and the recovery rate of JOA score were compared between 2 groups. Results The operation time and intraoperative blood loss of group A were significantly higher than those of group B（P〈0.05）. Dural tear occured in 4 cases of group A and 1 case of group B during operation; 6 cases had radicular symptoms after operation in group A; incision infection was found in 1 case of 2 groups respectively. The follow-up time was 24-36 months in group A and was 26-40 months in group B. No significant difference was found in the JOA score at preoperation and 2 weeks after operation between 2 groups（P〉0.05）. The JOA score and the recovery rate of JOA score of group A were significantly better than those of group B at 2 years after operation（P〈0.05）. X-ray film showed that the reduction rate of group A was significantly higher than that of group B after 2 weeks of operation（P〈0.05）; the reduction loss rate of group A was significantly lower than that of group B after 2 years after operation（P〈0.05）. The intervertebral space height of group A was significantly higher than that of group B at 2 weeks and 2 years after operation（P〈0.05）. T

关 键 词：峡部裂型腰椎滑脱症 内固定 椎间融合 后外侧融合 

分 类 号：R687.3[医药卫生—骨科学]