不同融合术式联合椎弓根复位内固定系统治疗峡部裂性腰椎滑脱症247例临床观察

目的研究不同融合术式(PLIF/PLF)联合椎弓根复位内固定系统治疗峡部裂性腰椎滑脱症的疗效及优缺点。方法回顾性分析PLIF和PLF术式联合椎弓根内固定系统治疗峡部裂性腰椎滑脱症247例,分别记录手术经过、效果和并发症。139例获得随访,其中PLIF术式72例,PLF术式67例,随访24～35个月,平均27.5个月,采用Otani标准评价随诊结果。结果平均手术时间,平均出血量,术前和术后椎间高度比较用两样本均数的T检验,使用SPSS 13.0医学软件包进行统计分析。平均手术时间,平均出血量有统计学差异(p<0.05)。行PLIF融合手术的平均手术时间和平均出血量大于PLF。两种融合术手术后的优良率采用χ2检验,结果无统计学差异(p>0.05)。结论PLIF及PLF术式联合椎弓根钉复位内固定均可达到椎管彻底减压,恢复腰椎生理曲度及椎间隙高度,防止术后腰椎失稳,是腰椎滑脱症治疗的有效术式。但PLIF术式能更好地恢复椎间隙高度,能有效地防止复位的丢失,而且其植骨融合速度快。

THE CLINICAL OBSERVATION OF THE TREATMENT OF 247 CASES ISTHMIC SPONDYLOLISTHESIS WITH DIFFERENT FUSION COMBINED PEDICLE SCREW FIXATION SYSTEM

Objective Study the efficacy and benefits of treatment of Isthmic spondylolisthesis with different fusion surgery（PLIF/PLF） combined RF-type pedicle screw fixation system. Methods Retrospectively analyze 247 cases of Isthmic spondylolisthesis treated with PLIF/PLF surgical combined pedicle screw fixation system.Recorded separately surgical procedure,effectiveness and complications.139 cases were followed-up（72 cases of PLIF surgical,67 cases of PLF surgical） for 24~35 months,the average was 27.5 months,followed up the results of evaluation using the Otani standard. Results The average operative time,the average amount of bleeding,preoperative and postoperative intervertebral height is two-sample T-tested using SPSS 13.0 Medical Statistical software,the average operation time and the average amount of bleeding has statistical difference（p0.05）,the average operation time and the average amount of bleeding of PLIF fusion surgery is greater than PLF.The post-operative excellent rates of two kinds of fusion surgery are χ2 tested;they have no statistical difference（p0.05）. Conclusion PLIF and joint PLF surgical pedicle screw fixation can achieve the complete spinal canal decompression,restore the lumbar lordosis and disc space height,thus preventing postoperative lumbar instability,therefore,PLIF and joint PLF surgical pedicle screw fixation is an effective surgical treatment for spondylolisthesis.However,compared with joint PLF surgical pedicle screw fixation,PLIF surgical is much better in recovery disc space height and lower of bone loss,so it can effectively prevent loss of reduction and enhance the fusion speed.