两种术式治疗腰椎间盘突出伴腰椎不稳症的疗效比较

目的:对比研究后正中入路后路腰椎椎间融合术(PLIF)与经椎旁肌间隙入路改良后路经椎间孔椎间融合术(TLIF)治疗腰椎间盘突出伴腰椎不稳症的临床疗效。方法:2009年4月-2011年5月我院收治的腰椎间盘突出伴腰椎不稳症患者78例,其中37例行后正中入路PLIF术,41例行经椎旁肌间隙入路改良TLIF术,比较2组患者手术时间、术中出血量及手术后JOA评分改善率、优良率、植骨融合率。结果:改良TLIF组术中出血量降低、手术时间缩短,与PLIF组比较,差异有统计学意义(P0.05);JOA评分改善率、优良率、植骨融合率均提高,但与PLIF组比较差异无统计学意义。结论:与后正中入路后路腰椎椎间融合术比较,经椎旁肌间隙入路改良后路经椎间孔椎间融合术更安全有效。

Comparison of curative effectiveness between two operation patterns for patients with lumbar inter-vertebral disc protrution and lumbar instability

Objective：To compare therapeutic effects of posterior lumbar interbody fusion（PLIF）from post-midline approach and modified transforaminal lumbar interbody fusion （TLIF）from paraspinal approach on treating lumbar intervertebral disc protrution and lumbar instability. Methods：A total of 78 patients with lumbar intervertebral disc protrution and lumbar in-stability were treated between April 2009 and May 2011,including 37 patients managed by PLIF and 41 patients managed by TLIF. The operation time,amount of intra-operative blood loss of patients were recorded and improvement rate of JOA score,excellent rate,bony union rate of patients were calculated. Results：Compared with PLIF group,operation time was shortened and amount of intra-operative blood loss was decreased in TLIF group （P〈0.05）;improvement rate of JOA score, excellent rate and bony union rate of TLIF group were increased,but there was no statistically difference. Conclusions：Mmodified transforaminal lumbar interbody fusion（TLIF）from paraspinal approach is securer and more effective on treating lumbar intervertebral disc protrution and lumbar instability than posterior lumbar interbody fusion（PLIF）from post-midline approach.