退变性腰椎滑脱三种后路融合方法的远期疗效比较

目的比较退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)3种后路融合方法的远期疗效。方法回顾性分析62例DLS患者的资料,按融合方法分为3组:A组后外侧融合,B组椎间自体髂骨融合,C组椎间Cage置入融合,进行5～9年的随访。对术前、术后及随访时影像学资料和临床评价指标进行比较。结果 3组间日本骨科学会(Japanese Orthopaedic Association,JOA)评分改善率、优良率和融合率等差异无统计学意义(P>0.05)。随访时3组滑脱复位率分别丢失(1.61±1.09)%、(0.88±1.45)%和(0.06±0.12)%,椎间高度分别丢失(2.00±0.77)mm、(0.39±0.35)mm和(0.03±0.18)mm,椎间盘角分别丢失2.78°±1.26°、1.39°±0.76°和0.75°±0.61°,差异均有统计学意义(P<0.05),C组丢失最少。结论 3种融合方法均能获得良好的远期临床疗效,椎间Cage置入融合有更好的影像学表现。

Comparison of long-term results of three posterior fusion methods for degenerative lumbar spondylolisthesis

Objective To compare the long-term results of 3 different posterior fusion methods in the treatment of degenerative lumbar spondylolisthesis. Methods The retrospective study analyzed the clinical data of 62 patients who were treated with different posterior fusion methods for degenerative lumbar spondylolisthesis. The patients were divided into 3 groups according to different fu- sion methods： Group A, posterolateral lumbar fusion; Group B, posterior lumbar interbody fusion with autologous ilium; Group C, posterior lumbar interbody fusion with Cage. These patients were followed up for 5 -9 years. The clinical and radiological results were evaluated through questionnaire and radiology examination. Results There were no significant differences among the Japanese Orthopaedic Association （JOA） scores recovery rates, excellent and good rates, fusion rates of the 3 groups （P 〉0. 05）. Reduction rates of the 3 groups lost （ 1.61 ± 1.09） %, （ 0. 88± 1.45） % and （ 0. 06 ± 0. 12 ） %, respectively. Intervertebral height lost （2.00 ± 0. 77）mm, （0. 39 ± 0. 35 ） mm and （0. 03 ± 0. 18）mm, respectively. Intervertebral angles lost 2.78°±1.26°、1.39°±0.76°and 0.75°±0.61° , respectively. There were statistical differences among the loss of reduction rate, intervertebral height and angle of the 3 groups （P 〈0.05）. The loss of Group C was the least. Condusion The 3 posterior fusion methods can achieve good clinical outcome of long term follow-up in treatment of degenerative lumbar spondylolistbesis. Posterior lumbar interbody fusion with Cage has a better radiographic improvement.