后路环状融合术治疗峡部裂性与退变性腰椎滑脱症效果比较

目的：比较后路环状融合术治疗峡部裂性与退变性腰椎滑脱症的疗效。方法：81例单节段腰椎滑脱症患者，其中峡部裂性滑脱（峡部裂组）39例，退变性滑脱（退变组）42例，均接受后路环状融合术治疗。采用Oswestry功能障碍指数（ODI）、疼痛视觉模拟评分（VAS）、椎间隙高度、腰椎前凸角、滑脱率及融合率比较两组疗效，并观察并发症情况。结果：所有患者均获得随访，随访时间14~49个月，平均24.8±7.6个月。峡部裂组手术时间及术中出血量均大于退变组，差异均有统计学意义（P<0.05）。两组术后1周ODI评分、VAS评分、椎间隙高度及腰椎前凸角均较术前改善，差异均有统计学意义（P<0.05），且均保持至末次随访时；而两组间个时间点比较，差异均无统计学意义（P>0.05）。术后1周两组间滑脱复位率差异无统计学意义（P>0.05），末次随访时复位丢失率峡部裂组为10.28%，高于退变组的3.09%，差异有统计学意义（P<0.05）。末次随访时峡部裂组融合率为92.3%，退变组为95.2%，差异无统计学意义（P>0.05）。峡部裂组硬脊膜撕裂4例，脑脊液漏2例，根性痛加重2例，感染1例。退变组硬脊膜撕裂1例，脑脊液漏2例，下肢静脉血栓形成1例。两组随访期内均无Cage松动、位移或下沉，椎弓根螺钉无松脱、折弯或断裂等情况。结论：腰椎后路环状融合术治疗峡部裂性与退变性滑脱的疗效相近，均有利于增加椎间隙高度，恢复生理前凸以及提高脊柱融合率。

Comparative analysis of posterior lumbar circumferential fusion for the treatment of isthmic and degenerative spondylolisthesis

Objectives:To compare the outcomes of posterior lumbar circumferential fusion (PLCF) for the treatment of isthmic and degenerative spondylolisthesis.Methods: 81 patients with one level of spondylolisthesis were retrospectively analyzed, with 39 cases of isthmic and 42 cases of degenerative types. The Oswestry disability index (ODI), visual analogue scale (VAS), disc space height, lumbar lordosis, slippage rate and fusion rate were evaluated. The complications were also recorded. Results: All patients underwent the surgery successfully, and were followed up for 14~49 months, with an average of 24.8±7.6 months. Both the surgical time and blood loss of the isthmic were greater than those of the degenerative cases (all P<0.05). The ODI, VAS, disc space height and lumbar lordosis improved on both groups at 1 week postoperatively compared with preoperatively (all P<0.05), and maintained at the final visit (all P>0.05). There was no significant difference on the above indexes between groups (all P>0.05). No significant difference was detected on the reduction rate between groups at 1 week (P<0.05). But significant difference on the reduction loss was observed between groups at the final visit (P>0.05). There was no significant difference on fusion rate between groups at the final visit (P>0.05). The complications included 4 cases of dura laceration, 2 cerebrospinal fluid (CSF) leakages, 2 aggravation of nerve root pain and 1 infection on isthmic group. One case of dura laceration, 2 CSF leakages and 1 thrombosis of the lower extremity occurred on the degenerative group. No loosening, shift or subsidence of cage, or broken of pedicle screw happened on both groups on the entire follow up. Conclusions: The isthmic and degenerative spondylolisthesis could obtain the similar results by the treatment of posterior lumbar circumferential fusion, which increase the disc space height, restore the lumbar lordosis, and increase the fusion rates.