不同植骨融合术治疗腰椎滑脱症的疗效比较分析

目的：比较3种不同植骨融合术治疗腰椎滑脱症的疗效。方法：自2006年1月至2008年12月共收治腰椎滑脱症患者85例,男36例,女49例;年龄38～65岁,平均51.8岁。采用3种手术方法：后外侧植骨融合术32例（A组）、后路椎体间植骨融合术28例（B组）、前路椎体间植骨融合术25例（C组）。疗效评定采用Nakai评分标准,骨性融合标准采用Suk标准判断。结果：所有患者均获得随访,随访时间均不少于2年。A组：优19例,良9例,中4例;B组：优16例,良9例,中3例;C组：优14例,良8例,中3例。A、B、C组的融合率分别为68.8%（22/32）、92.9%（26/28）、92.0%（23/25）。B、C组的椎间隙高度维持及融合率均优于A组（P〈0.05）。结论：对于治疗腰椎滑脱症,前路及后路椎体间植骨融合术在椎间隙高度维持及融合率优于后外侧植骨融合术,但腰椎滑脱症病情及伴随并发症多样化,应具体根据患者滑脱类型、程度、有无椎间盘突出及神经症状等做出相应的选择。

Analysis on effect of different bone graft fusion operations for lumbar spondylolisthesis

Objective: To compare the effects of different bone graft fusion for lumbar spondylolisthesis. Methods: From Jan. 2006 to Dec. 2008,85 patients(male 36 and female 49,the ranging in age from 38 to 65 with an average of 51.8 years) with lumbar spondylolisthesis were treated with different methods. Operative method included posterolateral lumbar fusion (PLF,group A,32 cases),posterior lumbar interbody fusion(PLIF,group B,28 cases) and anterior lumbar interbody fusion(ALIF,group C,25 cases). The effect and bone graft fusion were respectively evaluated with Nakai score and Suk standard. Results: All the patients were followed up no less than 2 years. In group A,19 cases got excellent result,good 9,fair 4;in group B,16 cases got excellent result,good 9,fair 3;in group C,14 cases got excellent result,good 8,fair 3. The rates of the excellent and good in group A,B,C were respectively 87.5%(28/32),89.3%(25/28),88.0%(22/25);and the rates of the bone fusion in group A,B,C were respectively 68.8%(22/32),92.9%(26/28),92.0%(23/25). Group B,C were better than of group A in maintainence of intervertebral space height,and in the rate of bone fusion(P<0.05). Conclusion: Anterior and posterior lumber interbody fusion has a better effect than posterolateral lumbar fusion in the maintainence of intervertebral space height and bone fusion,but the situations of lumbar spondylolisthesis is complex and diversifiable,the fusion method should be selected according to the type,degree of lumbar spondylolisthesis,lumber degeneration,nerve compression,etc.