椎弓根螺钉复位内固定后两种融合手术治疗腰椎滑脱症的临床疗效比较

目的比较椎弓根螺钉复位内固定后腰椎后路椎体间融合术(posterior lumbar interbody fusion,PLIF)和腰椎后外侧融合术(posterolateral lumbar fusion,PLF)治疗腰椎滑脱症的临床疗效。方法 68例腰椎滑脱患者椎弓根螺钉复位内固定后分别行PLIF36例(PLIF组)及PLF32例(PLF组)。结果患者均获随访,平均时间(3.0±0.5)年,两组在平均手术时间、术中出血量及并发症发生率、临床疗效优良率、植骨融合率等方面均无显著性差异(P0.05),两组术后1周和术后1年滑脱率、椎体高度及滑脱节段前凸角均优于术前(P0.01),但术后1年PLIF组在滑脱矫正、椎体高度及滑脱节段前凸角度等指标的维持方面均优于PLF组(P0.01)。结论椎弓根螺钉复位内固定后PLIF与PLF均为治疗腰椎滑脱症的有效方法,但PLIF对腰椎滑脱的矫正、椎间高度的维持、生理曲度的恢复等方面较PLF有显著的优越性。

Comparison of the Posterolateral Fusion and Posterior Lumbar Interbody Fusion after Pedicle Screw Fixation for Lumbar Spondylolisthesis

Objective To compare the clinical effects of posterolateral fusion（PLF）and posterior lumbar interbody fusion（PLIF）after reduction and fixation with pedicle screws in the treatment of lumbar spondylolisthesis.Method Retrospeactive analysis was used in 68 patients with lumbar spondylolisthesis,including PLF in 32 and PLIF in 36.Results All cases were followed up for average（3.0±0.5） years.The clinical effects,the fusion rate,the mean operation time,blood loss and complication rate of two groups remained no significant difference（P0.05）.However,in the correction of spondylolisthesis,the maintaining of the vertebral height and the anterior salient angle one year after operation,the PLIF group was better than PLF group,which was statistically significant（P0.01）.Conclusions PLF and PLIF after reduction with pedicle screw are both effective methods for lumbar spondylolisthesis.Comparing with the PLF,PLIF is a more effective treatment for low grade spondylolisthesis with superiority of the correction of spondylolisthesis,and the maintaining of the vertebral height and anterior salient angle.