摘要
目的比较采用不同内固定及植骨融合方式治疗腰椎滑脱症的手术疗效及适应证。方法以前路腰椎体间融合术(ALIF组,11例)及后路腰椎体间融合术(PLIF组,28例)治疗不同类型及合并症的腰椎滑脱症患者,比较两组的手术时间、出血量、腰痛疾患疗效(JOA评分)、生活质量(SF-36量表)、并发症、椎间高度及术后植骨融合率。结果PLIF组的手术时间为(238±28)min,显著长于ALIF组的(154±24)min(P<0．05)。PLIF组的出血量为(860±34)mL,显著多于ALIF组的(590±29)mL(P<0．05)。PLIF组无神经根损伤,ALIF组无输尿管及大血管损伤,所有男性患者均未发生因交感神经损伤所致的逆行射精等并发症。PLIF组手术前、后JOA评分分别为(13．2±2．5)和(22．9±3．1)分,ALIF组为(15．9±4．0)和(23．8±2．7)分,两组患者术后JOA评分均显著高于术前(P值均<0．05)。PLIF组、ALIF组术后SF-36量表评分分别提高65％和53％。PLIF组术后L4～L5、L5～S1椎间高度分别为(13．6±3．1)和(14．7±4.2)mm,ALIF组分别为(15．0±2．9)和(15．9±4．6)mm,两组的差异无统计学意义(P值均>0．05)。PLIF组术后植骨融合率为96％,ALIF组为100％,两组的差异无统计学意义(P>0．05)。结论两种术式均可达到理想效果,但应根据滑脱类型、程度及患者的临床表现加以选择。
Objective To investigate an ideal surgical technique for different types of lumbar spondylolisthesis and its indication. Methods Thirty nine patients with different types of lumbar spondylolisthesis and their complications were treated with posterior lumbar intervertebral fusion （PLIF） or anterior lumbar intervertebral fusion （ALIF） from Jan 2002 to Oct 2004. An observational study of operation duration, amount of bleeding during operation, the therapeutic effect, rate of bone graft fusion and disk height was carried out. Results The operation duration and bleeding amount of ALIF were less than those of PLIF （P〈0.05 for both）. JOA score was raised by 7.9, SF-36 score by 53 %, the anterior disk height （ 15.0 ± 2.9） mm （ L4 -L5 ） and （ 15.9 ± 4.6） mm （L5-S1） after operation, and within a follow-up period of 6 months to 2 years, the rate of bone graft fusion was 100% in ALIF. While in PLIF, the JOA score was raised by 9.7, SF-36 score by 65%, the anterior disk heights were （13.6±3.1） mm （L4-L5） and （14.7 ±4.2） mm （L5-S1）, and the rate of bone graft fusion was 96%. There were no significant difference between the outcomes of the two techniques. Conclusions Ideal effect can be achieved by both techniques. The technique used should conform to the type and extent of spondylolisthesis and clinical findings.
出处
《上海医学》
CAS
CSCD
北大核心
2007年第4期260-262,共3页
Shanghai Medical Journal
关键词
腰椎滑脱症
前路
后路
椎体间融合
内固定
Lumbar spondylolisthesis
Anterior
Posterior
Intervertebral fusion
Internal fixation
