不同植骨融合术治疗腰椎滑脱症的疗效分析

目的比较腰椎后外侧融合术(PLF)、腰椎后路椎间植骨融合术(PLIF)及腰椎经椎间孔椎间植骨融合术(TLIF)治疗腰椎滑脱症的临床效果。方法 118例腰椎滑脱患者,均予以椎弓根螺钉复位固定后行植骨融合术,其中行腰椎后外侧融合术36例(A组),腰椎后路椎间植骨融合术42例(B组),腰椎经椎间孔椎间植骨融合术40例(C组)。回顾性分析3组患者临床资料,比较3种植骨融合术的融合率及临床症状的改善情况。结果 C组的手术时间、术中出血量均明显低于A组和B组(P<0.05),但C组的植骨融合率明显高于A组和B组(P<0.05);A、B、C组的优良率分别为77.8%、83.3%和95.0%,3组间比较无统计学差异(P>0.05)。结论联合椎弓根螺钉系统复位固定,有利于提高植骨融合率,减少并发症;腰椎经椎间孔椎间植骨融合术具有手术时间短、出血量少、椎间融合面积大、融合率高等优点,值得临床推广应用。

A Comparative Study of Bone Fusion for Lumbar Spondylolisthesis by Three Methods

Objective To compare the therapeutic effect of posterolateral lumbar fusion(PLF),posterior lumbar interbody fusion(PLIF) and trans-foraminal lumbar interbody fusion(TLIF) for lumbar spondylolisthesis.Methods According to three different fusion methods,120 patients with lumbar spondylolisthesis were divided into 3 groups: group A(PLF,n=36);group B(PLIF,n=42) and group C(TLIF,n=40).After the pedicle screws-rod internal fixation,all the patients were operated by different fusion methods.Clinical outcome and fusion rates of the three groups were reviewed and compared.Results Operation time and blood loss in group C were much lower than group A and B(P<0.05),but bone fusion rate in C group was much higher than group A and B(P<0.05).The good rate of group A,B and C were 77.8%,83.3% and 95.0% respectivly,but there was no statistically significant difference among the three groups(P>0.05).Conclusion Pedicle screws-rod internal fixation is a better way to raise bone fusion rate and reduce complications.TLIF with shorter operation time,lower blood loss,larger fusion area and higher bone fusion rate,is a good method for the treatment of spondylolisthesis.