两种植骨融合术治疗腰椎滑脱症的临床研究

目的比较后路腰椎椎间植骨融合术（PLIF）和后外侧植骨融合术（PLF）治疗峡部裂性腰椎滑脱症的临床疗效。方法回顾性分析本院自2010年3月至2012年5月收治手术治疗峡部裂性腰椎滑脱症并获得完整随访资料的患者47例，男22例，女25例；年龄42-67岁，平均54.3岁。根据Meyerding分型，Ⅰ型17例，Ⅱ型28例，Ⅲ型2例。其中PLIF组的25例，PLF组的22例。分析手术时间、出血量及并发症，对术前术后JOA评分、腰腿痛VAS评分及影像学指标进行随访，进行统计学分析。结果平均手术时间：PLIF组（186．64±30．33）min，PLF组（154．48±42．27）min；平均出血量：PLIF组（543．24±72．24）rnl，PLF组（423．67±54．33）ml，两组差异有统计学意义（P〈0．05）。随访时PLIF组滑脱率（8．4±5．1）％，椎间隙高度（0．312±0．039）％，椎间孔面积（0．169±0．023）％；PLF组滑脱率（14.3±6．2）％，椎间隙高度（0．233±0．041）％，椎间孔面积（0．138±0．025）％，各差异有统计学意义（P〈0．05）。PLIF组和PLF组JOA、VAS评分术后均高于术前，有统计学意义（P〈0．05）；组间比较，术前、术后评分无显著差异（P〉0．05）。结论PLIF和PLF在治疗腰椎滑脱症均取得了相当疗效，与PLIF相比，PLF在缩短手术时间、减少出血及降低并发症发生率方面效果更好，而PLIF在维持椎间高度、椎问孔面积以及矫正滑脱率方面疗效更为显著。

Clinical effects comparison between two different fusion methods in the treatment of isthmic spondylolisthesis

Objective To compare the clinical effects of posterior lumbar interbody fusion （PLIF） and posterolateral lumbar fusion （PLF） in the treatment ofisthmic lumbar spondylolisthesis. Methods Follow-up data of 47 patients with isthmic lumbar spondylolisthesis were retrospectivdy analyzed from March 2010 to May 2012. There were 22 males and 25 females with a mean age of 54.3 years. According to Meyerding grading system, 17 cases were classified as grade Ⅰ, 28 as grade Ⅱ and 2 as grade Ⅲ. The operation time, blood loss and surgery associated complication were evaluated. The JOA and VAS were measured before and after surgery to evaluate improvement of low back and leg pain. Some radiological parameters, such as disc height, intervertebral foramen area and slipping rate were calculated before and after surgery. Results The average operation time and blood loss of PLIF group were （186.64±30.33） rain and （543.24±72.24） ml, while （154.48±42.27） rain and （423.67±54.33） ml in PLF group and there were statistical significance. PLIF group was better than PLF group in radiological measurement with statistical significance. The postsurgical JOA and VAS evaluation of both groups were higher than pre-surgical while both pre- and post-surgical JOA and VAS evaluation between two groups didn＇t show any significance. Conclusions Both PLIF and PLF are effective in the treatment of isthmic spondylolisthesis. PLF have advantage over PLIF in decreasing blood loss, lowering complication incidence and shortening operation time while PLIF play a better job than PLF in maintaining disc height, intervertebral foramen area and correcting slipping rate.