3种不同术式治疗伴Ⅰ度退行性滑脱的腰椎管狭窄症效果观察  

The effect of three different surgical treatment on lumbar stenosis withⅠdegree degenerative spondylolisthesis

作　　者：李一鹏[1] 田玉良[1] 于海泉[1] 曹斌[1] 王猛[1] 苏敬阳[1] 

机构地区：[1]河北省石家庄市第一医院骨三科,河北石家庄050011

出　　处：《河北医科大学学报》2016年第7期793-797,805,共6页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题(ZL20140288)

摘　　要：目的观察单纯减压、椎间孔入路椎间融合术(transforaminal lumbar interbody fusion,TLIF)、经后路椎间融合术(posterior lumbar interbody fusion,PLIF)治疗伴Ⅰ度退行性滑脱的腰椎管狭窄症的效果。方法选择伴Ⅰ度退行性滑脱的腰椎管狭窄症患者103例,均为单侧症状严重者,分为3组:单纯减压组38例、TLIF组31例和PLIF组34例。比较3组术中指标及术后6个月、2年随访时的滑脱程度、腰腿疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分、日本骨科协会(Japanese Orthopedic Association,JOA)评分,比较TLIF组及PLIF组术后植骨融合情况,比较3组治疗效果。结果 TLIF组和PLIF组手术时间、术中失血量及术后引流量明显多于单纯减压组,而术后卧床时间明显少于单纯减压组。PLIF组手术时间、术中失血量及术后引流量显著多于TLIF组(P<0.05)。3组间疗效和并发症发生率差异无统计学意义(P>0.05)。TLIF组及PLIF组腰疼痛VAS评分呈逐渐下降趋势,单纯减压组腰疼痛VAS评分呈先下降后升高趋势,3组腿疼痛VAS评分均呈下降趋势,3组不同时点间、组间·不同时点间交互作用差异有统计学意义(P<0.05)。TLIF组及PLIF组术后6个月及2年时滑脱程度逐渐降低,单纯减压组滑脱程度呈逐渐加重趋势,3组组间、不同时点间、组间·不同时点间交互作用差异均有统计学意义(P<0.05)。术后6个月复查时,TLIF组未融合1例,PLIF组未融合2例;术后2年复查时,2组均融合。结论对于伴Ⅰ度退行性滑脱的腰椎管狭窄症患者,单纯开窗减压手术损伤小,TLIF和PLIF的远期效果更佳。TLIF手术失血量、住院时间、对神经和硬膜损伤等均少于PLIF。应用TLIF手术治疗伴Ⅰ度退行性滑脱的腰椎管狭窄症更安全、有效。Objective To compare the effects of simple decompression,transforaminal lumbar interbody fusion（ TLIF）,posterior lumbar interbody fusion（ PLIF） on lumbar stenosis with Ⅰ degree degenerative spondylolisthesis. Methods One hundred and three cases with severe unilateral symptoms,suffering from lumbar stenosis with Ⅰ degree degenerative spondylolisthesis were diveded into three groups： simple decompression group（ 38 cases）,transforaminal lumbar interbody fusion（ TLIF,31cases） and posterior lumbar interbody fusion（ PLIF,34 cases）. Intraoperative index,the degree of spondylolisthesis,lumbocrural pain visual analogue scale（ VAS）,and Japanese Orthopedic Association（ JOA） score were compared in the 3 groups at 6 months and 2 years of follow-up. postoperative bone graft fusion situation were compared in TLIF and PLIF group. The efficacies of treatment of the 3 groups were analyzed. Results The operation time,intraoperative blood loss and operation drainage of TLIF group and PLIF group were significantly higher than those of simple decompression group,and the postoperative bed rest time was significantly lower than that of simple decompression group. The operation time,intraoperative blood loss and postoperative drainage of PLIF groups were significantly higher than those of TLIF group（ P〈0. 05）. There was no significant difference in the curative effect and complication rate in the 3 groups（ P〈0. 05）. lumbago VAS score was gradually decreased in TLIF and PLIF group,but was decreased first and then increased simple decompression group. VAS score of leg pain in 3 groups were decreased. There were significant differences in the interaction between the two groups at the same time,the difference between the two groups（ P〈0. 05）. Progression of spondylolisthesis of TLIF and PLIF at postoperative 6 months and 2 years were decreased gradually,but simple decompression group showed a gradually increasing trend,and the difference is statistically significant in the groups and time p

关 键 词：椎管狭窄 脊椎滑脱 脊柱融合术 

分 类 号：R681.5[医药卫生—骨科学]