退变性腰椎滑脱后路融合术对腰椎曲度的影响

目的 分析退变性腰椎滑脱后路融合术对腰椎曲度的影响，比较三种后路融合术后腰椎曲度的变化。方法 回顾性分析62例接受过后路减压、复位、融合、椎弓根螺钉系统内固定术的退变性腰椎滑脱患者的资料，根据融合方式分为三组：Ａ组（26例）后外侧植骨融合；Ｂ组（20例）椎间自体骨块植骨融合；Ｃ组（16例）椎间融合器（Cage）植入融合。进行5～9年（平均6.4年）的随访，通过影像学资料对患者术前、术后即刻及末次随访时滑脱节段椎间高度、椎间盘角、侧凸角、腰骶角和全腰椎前凸角等腰椎曲度指标进行比较，运用SPSS13.0软件进行统计学分析，P＜0.05为差异有统计学意义。结果 术后滑脱复位率三组间比较差异无统计学意义（P＞0.05），末次随访时三组间复位率丢失差异有统计学意义（P＜0.05），Ｃ组丢失最少；末次随访时三组间融合率差异无统计学意义（P＞0.05）。术后滑脱节段椎间高度、椎间盘角、侧凸角、腰骶角和全腰椎前凸角较术前均有显著改善（P＜0.05）。这些指标在末次随访时均较术后即刻检查结果有所丢失，其中椎间高度、椎间盘角和全腰椎前凸角的丢失有统计学意义（P＜0.05）；腰椎曲度的丢失中，Ａ组丢失最多，Ｂ组次之，Ｃ组最少，三组间比较差异有统计学意义（P＜0.05）。结论 对于退变性腰椎滑脱，经过减压、椎弓根钉系统进行复位和内固定，能很好地恢复腰椎生理曲度，行椎间Cage植入融合可使其长期得以良好的维持。

Effects of posterior fusion surgery for degenerative lumbar spondylolisthesis on the lumbar curvature

Objective To investigate the effect of posterior fusion on lumbar curvature and compare the diversification of lumbar curvature with 3 different posterior fusion methods in the treatment of degenerative lumbar spondylolisthesis. Methods 62 degenerative lumbar spondylolisthesis patients who were treated with posterior decompression, reset, fusion, fixation with pedicle screw system were retrospectively analysed. The patients were divided into 3 groups according to fusion methods. Group A： posterolateral lumbar fusion （PLF） （26 cases）. Group B： posterior lumbar interbody fusion （PLIF） with autologous ilium （20 cases）. Group C： PLIF with cage （16 cases）. The follow-up time ranged from 5 years to 9 years. The lumbar curvatures of these patients were compared by imaging data of the intervertebral height of the slippage level, intervertebral angle, lateral convex angle, lumbosacral angle, and lumbar lordosis angle preoperatively, postoperatively and in the last follow-up. SPSS 13.0 was used for statistical analysis and P〈0.05 was considered statistically significant. Results Postoperative spondylolisthesis reset rate among the 3 groups showed no significant difference （P〉0.05）. There was significant differences among the 3 groups’ loss of reset rate at the last follow-up （P〈0.05）. Group C was of minimal loss. No significant difference existed for the fusion rate among the 3 groups at the last follow-up （P〉0.05）. Compared with preoperative condition, postoperative intervertebral height, intervertebral angle, scoliosis angle, lumbosacral angle and lumbar lordosis were significantly improved （P〈0.05）. There was a certain loss of improvement at the last follow-up compared with postoperative. The loss of intervertebral height, intervertebral angle and lumbar lordosis angle were significant （P〈0.05）. There was significant differences among the loss of lumbar curvature of the 3 groups （P〈0.05）. The most loss of these indexes occurred in the patients of group A, followed by Group B, and Group C at least. Conclusions Lumbar curvature could be well restored through decompression and fixation by pedicle screw system in the treatment of degenerative lumbar spondylolisthesis. Good results could be maintained by PLIF with cage during long term follow-up.