摘要
目的比较经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)与后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗腰椎滑脱症的临床疗效。方法2010年3月~2014年3月我院治疗的腰椎滑脱症病人62例,按手术方法分为TLIF组36例,PLIF组26例,首先采用椎弓根螺钉固定,然后分别通过椎间孔椎体间融合器融合或后路融合器椎间融合,应用钉棒提拉结合融合器撑开复位。比较两组的手术时间、术中出血量、术后引流量及并发症。临床疗效采用疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)进行评价,根据X线片评价椎间融合情况。结果62例病人均顺利完成手术,PLIF组2例术中硬膜囊撕裂,1例出现神经根损伤。TLIF组手术时间为(134.17±27.40)分钟,PLIF组为(130.38±30.00)分钟,两组比较差异无统计学意义(P>0.05);两组术中出血量、术后引流量比较差异有统计学意义(P<0.05)。所有病人均获随访,TLIF组随访时间12~48个月,平均20个月;PLIF组随访时间9~42个月,平均18个月;两组术后、末次随访时VAS、ODI评分与术前比较,差异有统计学意义(P<0.05);TLIF组术后、末次随访VAS、ODI评分与PLIF组比较差异无统计学意义(P>0.05)。PLIF组1例出现融合器移位,无神经症状,TLIF组1例出现伤口脂肪液化,两组椎弓根系统无松动及断裂,椎间融合率分别为94.4%及92.3%,植骨融合时间平均为6.5个月。结论应用TLIF、PLIF技术均能行有效的减压及椎间融合,结合后路内固定,均能达到稳定椎体、减轻临床症状的目的,但TLIF组创伤小、神经及硬膜囊损伤发生率低,对于后结构保护更好。
Objective To compare the therapeutic effect of transforminal lumbar interbody fusion(TLIF)with posterior lumbar interbody fusion(PLIF)in treatment of lumbar spondylolisthesis.Methods From March 2010 to March 2014,a total of 62 patients suffering from lumbar spondylolisthesis were divided into 2 groups.36 patients in group underwent TLIF.26 patients in group underwent PLIF.Posterolateral fixation with pedicle screw and decompression,interbody fusion through TLIF or PLIF technical combined with cage for distraction reduction.The application of statistics analysis of the indicators compared between the two groups,including operating time,blood loss and volume of drainage after operation.VAS,ODI evaluating standards were applied to evaluate the therapeutic effect.The intervertebral height and bone fusion were observed by X ray.Results All patients underwent surgery safely without severe complications occurred.2 cases occurred dural tear and 1 of nerve root injury in PLIF group.There was no significant difference in general materials and operation time between TLIF group[(134.17±27.40)min]and PLIF group[(130.38±30.00)min](P>0.05).The blood during operation,volume of drainage after operation of TLIF group were significantly less than PLIF(P<0.05).The average following up time was 20 months(12~48 months)in TLIF group and 18 months(9~42 months)in PLIF group.Compared with preoperative parameters,the scores of VAS and ODI decreased significantly after surgery and at the final follow-up in both groups(P<0.05).But there was no significantly difference between TLIF and PLIF in VAS and ODI score(P>0.05).It occurred cage dislocation with no nerve symptom in PLIF group in 1 cases.1 case of fat liquefaction of incision injure happened in TLIF group.At the follow-up after 6.5 monthspostoperatively,the fusion is 94.4%in TLIF and 92.3%in PLIF,and no broken screw.Conclusion TLIF and PLIF technical both have a good clinical results in the treatment of lumbar spondylolisthesis which can achieve stable and effective decompression.With a less invasive and a less rate of nerve injury compared with PLIF,TLIF procedure can be performed easily and better protection the structure with less complications.
作者
李智
吴海辉
王德国
LI Zhi;WU Haihui;Wang Deguo(Department of Orthopedics,Zhongshan Hospital Qingpu Branch,Shanghai 201700,China)
出处
《临床外科杂志》
2020年第1期73-77,共5页
Journal of Clinical Surgery
关键词
腰椎滑脱症
椎弓根螺钉固定
经椎间孔椎体间融合
后路腰椎椎体间融合
lumbar spondylolisthesis
pedicle screw fixation
transforaminal lumbar interbody fusion
posterior lumbar interbody fusion
作者简介
通信作者:王德国,Email:910465833@qq.com
