单枚与双枚椎间融合器植骨融合联合椎弓根钉棒系统内固定治疗腰椎滑脱的对比研究

目的：比较单枚与双枚椎间融合器植骨融合联合椎弓根钉棒系统内固定治疗腰椎滑脱的临床疗效及安全性.方法：回顾性分析134例腰椎滑脱患者的病例资料,其中采用单枚椎间融合器植骨融合联合椎弓根钉棒系统内固定71例（单枚组）,采用双枚椎间融合器植骨融合联合椎弓根钉棒系统内固定63例（双枚组）;Meyerding Ⅰ度滑脱40例,Ⅱ度滑脱57例,Ⅲ度滑脱37例;L3～4滑脱10例,L4～5滑脱94例,L5S1滑脱30例.记录并比较2组患者的手术时间、术中出血量、术后引流量、腰椎疼痛视觉模拟评分、腰椎Oswestry功能障碍指数、椎间植骨融合率及术后并发症的发生情况.结果：①一般指标.单枚组的手术时间、术中出血量及术后引流量均小于双枚组（90.0±25.0）min,（115.0±35.0） min,t=-4.797,P=0.000; （210.0±100.0） mL,（320.0±120.0）mL,t=-5.786,P=0.000;（80.0±50.0） mL,（130.0±45.0） mL,t=-6.054,P=0.000].术后6个月,单枚组椎间植骨融合71例,双枚组椎间植骨融合63例;2组患者椎间植骨融合率比较,差异无统计学意义（P =1.000）.②腰椎疼痛视觉模拟评分.术后4周,2组患者的腰椎疼痛视觉模拟评分均较术前降低（8.0±1.3）分,（2.3±0.8）分,t=31.465,P=0.000; （8.1±1.1）分,（2.2±1.0）分,t=31.501,P=0.000];2组患者腰椎疼痛视觉模拟评分下降幅度比较,差异无统计学意义（5.7±1.2）分,（5.9±1.3）分,t=-0.926,P=0.356].③腰椎Oswestry功能障碍评分.术后4周,2组患者的腰椎Oswestry功能障碍评分均较术前降低（35.0±4.5）分,（8.1±1.4）分,t=48.096,P=0.000;（34.5±4.3）分,（8.0±1.1）分,t=47.390,P=0.000];2组患者腰椎Oswestry功能障碍评分下降幅度比较,差异无统计学意义（26.9±4.8）分,（26.5±3.9）分,t=0.525,P=0.6003.④安全性指标.2组患者均未发生内固定松动、断裂.单枚组1例患者发生脑脊液漏;双枚组7例患者发生脑脊液漏,5例患者发生感染.单枚组?

A retrospective trial of interbody fusion with one versus two cages combined with pedicle screw internal fixation for treatment of lumbar spondylolisthesis

Objective：To compare the clinical curative effects and safety of interbody fusion with one versus two cages combined with pedicle screw internal fixation for treatment of lumbar spondylolisthesis. Methods：The medical records of 134 patients with lumbar spon- dylolisthesis were analyzed retrospectively. Seventy-one patients（ one-cage group）were treated with interbody fusion with one cage combined with pedicle screw internal fixation, while the others （two-cage group）were treated with interbody fusion with two cages combined with pedi- cle screw internal fixation. The lumbar spondylolisthesis belonged to Meyerding types I （40）, II （57）and llI （37）and located in L3_4 （ 10）, L4_ s （94） and Ls - S1 （30）. The operative time, blood loss, postoperative drainage, low back visual analogue scores （ VAS）, Oswestry disability index（ ODI）, intervertebral bone fusion rate and postoperative complications were recorded and compared between the 2 groups. Results：The operative time, blood loss and postoperative drainage of one-cage group were less compared to two-cage group（90.0 ＋/-25.0 vs 115.0 ＋/- 35.0 min, t = - 4. 797, P = 0. 000 ; 210.0 ＋/- 100.0 vs 320.0 ＋/- 120.0 ml, t = - 5. 786, P = 0. 000 ; 80.0 ＋/- 50.0 vs 130.0 ＋/-45.0 ml, t = -6. 054, P = 0. 000）. Six months after surgery,71 patients in one-cage group and 63 patients in two-cage group got intervertebral bone fusion. There were no statistical differences in the intervertebral bone fusion rate between the two groups （ P = 1. 000）. Four weeks after surgery, the low back VAS of all patients in the two groups decreased （ 8.0 ＋/- 1.3 vs 2.3 ＋/- 0.8 points, t = 31. 465, P = 0.000 ;8.1 ＋/-1.1 vs 2.2 ＋/-1.0 points ,t = 31. 501 ,P = 0. 000）. There were no statistical differences in the decreased VAS between the two groups（5.7 ＋/- 1.2 vs 5.9 ＋/- 1.3 points ,t = -0. 926 ,P =0. 356）. Four weeks after surgery,the lumbar vertebrae ODI of all patients in the two groups decreased（35.0 ＋/-4.5 vs 8.