摘要
目的比较前路腰椎椎体间融合术（anteriorlumbarinterbodyfusion，ALIF）、后路椎体间融合术（posteriorlumbarinterbodyfusion，PLIF）、经椎间孔椎体间融合术（transforaminallumbarinterbodyfusion，TLIF）治疗椎弓根峡部裂导致的椎体轻度滑移的临床疗效和影像学改变。方法回顾性分析2004年5月至2014年5月因腰椎椎弓根峡部裂导致的椎体轻度滑移而接受椎间融合术患者70例。根据患者术前临床症状、神经压迫情况、大血管分叉位置和椎间隙前方“血管窗”宽度采用不同的手术方式，其中采用ALIF21例[男13例，女8例；年龄29-53岁，平均（43．29±8．15）岁；MeyerdingI级10例，Ⅱ级11例；L4．5 10例，L5S111例]，采用PLIF25例[男12例，女13例；年龄25-64岁，平均（44．04±12．71）岁；MeyerdingI级15例，Ⅱ级10例；L4.5 12例，L5S1 13例]，采用TLIF24例[男12例，女12例；年龄34-62岁，平均（45．00±9．36）岁；MeyerdingI级11例，Ⅱ级13例；L4.5 12例，L5S1 12例]。结果患者随访时间24-37个月，平均（25．6±8．7）个月。ALIF、PLIF、TLIF组视觉模拟评分（visualanaloguescale，VAS）分别由术前平均（7．05±0．87）分、（6．60±1．39）分、（6．75±1．11）分降至术后24个月平均（0．90±0．70）分、（0．96±0．68）分、（1．04±0．62）分；三组Oswestry功能障碍指数（Oswestrydisabilityidex，ODI）分别由术前平均78．53％±6．25％、79．80％±6．55％、79．92％±8．10％降至术后24个月平均17．14％±3．01％、21．32％±4．40％、22．46％±3．87％。手术时间、术中出血量、术后引流量及住院天数，ALIF组与TLIF组均无统计学差异，与PLIF组比较均有统计学差异。影像学显示，ALIF组L4.5及L5S1节段术后腰椎前凸角和椎间高度分别与PLIF组比较均无统计学差异，但与TLIF组比较有统计学差异。ALIF组L4.5及L5S1节段平均节段性前凸角与PLIF组和TLIF组比较均有
Objective To compare the clinical and radiographic outcomes of 3 kinds of lumbar interbody fusion （ALIF, PLIF, TLIF） for adult low-grade isthmic spondylolisthesis at L4.5 and L5S1 levels. Methods Data of seventy patients with low- grade isthmie spondylolisthesis who had undergone different lumbar interbody fusion （LIF） procedures according to the assessment of the clinical manifestation, neurological symptoms, plane of the common iliae vessels and the width of ＂vascular window＂ by three-dimensional computed tomography angiography between May 2004 and May 2014 were retrospectively reviewed. 21 patients had undergone anterior LIF （ALIF）（13 males and 8 females with an average of 43.29±8.15 years old （range, 29-53 years old）; I4.5 in ten, L5S1 in 11; Meyerding grade I 10 cases, grade II 11 cases）; 25 patients had undergone posterior LIF （PLIF） （12 males and 13 females, with an average of 44.04±12.71 years old （range, 25-64 years old）; L4.5 in 12, L5S1 in 13; Meyerding grade I 15 cases, grade II 10 cases） and 24 patients had undergone transforaminal LIF （TLIF） （12 males and 12 females with an average of 45.00± 9.36 years old （range, 34-62 years old）; L4.5 in 12, L5S1 in 12; Meyerding grade I 11 cases, grade II 13 cases）. Results All pa- tients were followed up for 24-37 months （average, 25.6± 8.7 months）. The visual analogue scale （VAS） in all groups were de- creased from 7.05±0.87 （ALIF）, 6.60±1.39 （PLIF）, 6.75±1.11 （TLIF） pre-operation to 0.90±0.70, 0.96±0.68, 1.04±0.62 24 monthsafter operation. Oswestry disability index （ODI） scores were decreased from 78.53%±6.25%, 79.80%±6.55%, 79.92%±8.10% pre- operation to 17.14%±3.01%, 21.32%±4.40%, 22.46%±3.87%. Perioperative data including operation time, blood loss, postopera- tive blood drainage, length of stay showed no significant difference between ALIF group and TLIF group, but showing significant difference comparing with PL1F group. The imageological results showed that ALIF proce
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第9期562-569,共8页
Chinese Journal of Orthopaedics
基金
浙江省自然科学基金（LY13H060011）
关键词
脊柱融合术
腰椎
脊椎滑脱
外科手术
Spinal fusion
Lumbar vertebrae
Spondylolysis
Surgical procedures, operative
