保留棘突韧带复合体经椎间孔椎体间融合治疗腰椎滑脱症

目的探讨保留棘突韧带复合体经椎间孔椎体间融合(TLIF)治疗腰椎滑脱症的疗效。方法将108例行TLIF治疗的腰椎滑脱症患者根据治疗方式不同分为观察组(术中保留棘突韧带复合体,55例)和对照组(术中不保留棘突韧带复合体,53例)。比较两组术后24个月椎间融合情况、术后各时间点腰椎JOA评分、末次随访时邻椎退变情况。结果患者均获得随访,时间36~47(40.2±5.3)个月。术后24个月椎间融合率两组比较差异无统计学意义(P>0.05)。腰椎JOA总分术后3个月两组比较差异无统计学意义(P>0.05),术后6、12个月对照组均低于观察组(P<0.05)。术后并发症总发生率对照组为24.53%,观察组为10.91%,差异有统计学意义(P<0.05)。末次随访时邻椎退变发生率对照组为15.09%,观察组为5.45%,差异有统计学意义(P<0.05)。结论保留棘突韧带复合体的TLIF治疗腰椎滑脱症不影响椎间融合率,且对于中后期腰骶部术后功能恢复有积极的意义。

Preserving spinous process ligament complex and transforaminal lumbar interbody bone grafting fusion in the treatment of lumbar spondylolisthesis

Objective To investigate the effect of transforaminal lumbar interbody fusion(TLIF)on lumbar spondylolisthesis by preserving spinous process ligament complex.Methods According to different treatment method,108 patients who underwent TLIF for treatment of lumbar spondylolisthesis were divided into observation group(intraoperative preserving spinous process ligament complex,55 cases)and control group(intraoperative without preserving spinous process ligament complex,53 cases).The following data of two groups were compared,including the postoperative intervertebral fusion of 24 months posoperation,lumbar JOA scores at different postoperative time points,the situation of adjacent segment degeneration(ASD)at the last follow-up.Results All patients in both groups were followed up for 36~47(40.2±5.3)months.There was no significant difference in the intervertebral fusion rate at 24 months after surgery between the two groups(P>0.05).The total lumbar JOA score:there was no significant difference between the two groups at 3 months after the operation(P>0.05),and the control group was both lower than the observation group at 6,12 months postoperation(P<0.05).The total incidence rate of postoperative complications was 24.53%in the control group,and 10.91%in the observation group,with statistically significant difference(P<0.05).At the last follow-up,the incidence rate of ASD in the control group was 15.09%and 5.45%in the observation group,with statistically significant difference(P<0.05).Conclusions TLIF with spinous process and ligament complex preservation for lumbar spondylolisthesis does not affect the intervertebral fusion rate,and has positive significance for the recovery of lumbosacral function in the middle and late stage.