3种不同手术方式治疗腰椎滑脱症的临床疗效分析  

Analysis of the clinical efficacy of three different surgical approaches in the treatment of lumbar spondylolisthesis

作　　者：张世磊 甘璐 罗卓荆[1] 丁子毅 闫铭 ZHANG Shilei;GAN Lu;LUO Zhuojing;DING Ziyi;YAN Ming(Department of Orthopaedics,Xijing Hospital of the Air Force Medical University,Xi′an,Shannxi 710032,China)

机构地区：[1]中国人民解放军空军军医大学西京医院骨科,西安710032

出　　处：《重庆医学》2020年第22期3724-3728,3732,共6页Chongqing medicine

基　　金：国家自然科学基金青年项目(81301581)。

摘　　要：目的比较不同手术方式治疗腰椎滑脱症的疗效。方法回顾性分析2013年2月至2017年5月该院收治的96例腰椎滑脱症患者临床资料,其中31例行腰椎后路椎板切除减压,后外侧植骨融合内固定术(PLF);35例行腰椎后路椎板切除减压,椎间盘切除,椎间植骨融合内固定术(TLIF);30例行微创通道下腰椎后路椎板切除减压,椎间盘切除,椎间植骨融合内固定术(MIS-TLIF),所有患者均随访2年。比较3组手术时间、术中出血量、滑脱复位率、复位丢失率、Oswestry功能障碍指数(ODI)评分、日本骨科协会(JOA)下腰痛评分。结果MIS-TLIF组手术时间明显长于PLF组和TLIF组(P<0.05);术中出血量MIS-TLIF组较PLF组、TLIF组明显减少(P<0.05)。TLIF组、MIS-TLIF组术后2年滑脱复位率明显高于PLF组(P<0.05),复位丢失率明显低于PLF组(P<0.05);术后2年ODI评分3组间无明显差异(P>0.05),TLIF组、MIS-TLIF组JOA下腰痛评分明显高于PLF组(P<0.05),JOA评分改善率明显高于PLF组(P<0.05)。结论与后外侧融合相比,椎间融合能更好地复位滑脱椎体,而微创通道手术能明显减少手术创伤,有良好的临床疗效。Objective To compare the efficacy of different surgical approaches in the treatment of lumbar spondylolisthesis.Methods The clinical data of 96 patients with lumbar spondylolisthesis admitted to this hospital from February 2013 to May 2017 were retrospectively analysed.Among these patients,31 patients underwent posterior lumbar laminectomy and decompression,posterolateral fusion(PLF)and internal fixation,35 patients underwent posterior lumbar laminectomy and decompression,discectomy and transforaminal lumbar interbody fusion(TLIF),and 30 patients underwent minimally invasive posterior lumbar laminectomy and decompression,discectomy and minimal invasive transforaminal lumbar interbody fusion(MIS-TLIF).All patients were followed up for 2 years.The operation time,intraoperative blood loss,spondylolisthesis reduction rate,reduction loss rate,Oswestry dysfunction index(ODI)score,and Japanese Orthopedic Association(JOA)low back pain score were compared among the three groups.Results The operation time in the Mis-TLIF group was significant longer than that in the PLF group and the TLIF group(P<0.05),and the intraoperative blood loss in the Mis-TLIF group was significantly lower than that in the PLF group and the TLIF group(P<0.05).Compared with the PLF group,the spondylolisthesis reduction rate in the TLIF group and the Mis-TLIF group increased significantly after two years follow-up(P<0.05),and the reduction loss rate was significantly decreased(P<0.05).No statistically significant difference was found in the ODI score among the three groups after two years follow-up(P>0.05).The JOA low back pain score as well as the JOA score improvement rate in the TLIF group and the Mis-TLIF group were significantly higher than those in the PLF group(P<0.05).Conclusion Compared with posterolateral fusion,intervertebral fusion can better reduce spondylolisthesis,and minimally invasive surgery has good clinical effects that can significantly reduce surgical trauma.

关 键 词：脊椎滑脱 腰椎 椎间融合 后外侧融合 微创性外科手术 

分 类 号：R681.5[医药卫生—骨科学]