摘要
目的比较经椎间孔腰椎椎间融合术(TLIF)和后外侧腰椎椎间融合术(PLIF)治疗退变性腰椎滑脱症(DLS)的临床疗效和影像学变化。方法收集2008年3月—2014年3月在本院采用TLIF(n=64)和PLIF(n=52)治疗的退变性腰椎滑脱症患者的临床资料,包括疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、融合率和医源性神经功能损伤(INRD)情况,以及手术节段滑脱程度、腰椎前凸角度、椎间隙后缘高度、椎间孔高度。结果两组的融合率和神经功能恢复情况差异无统计学意义(P>0.05)。两种术式术后VAS评分、ODI改善率差异无统计学意义(P>0.05)。术后PLIF组术侧神经功能损伤发生率高于TLIF组,差异有统计学意义(P<0.05);对侧肢体的神经功能损伤发生率TLIF组高于PLIF组,差异有统计学意义(P<0.05)。末次随访时,TLIF组在维持局部腰椎前凸角度方面优于PLIF组,差异有统计学意义(P<0.05);PLIF组在恢复椎间隙后缘高度、椎间孔高度方面优于TLIF组,差异有统计学意义(P<0.05)。结论 TLIF及PLIF在INRD发生率,恢复局部腰椎前凸角度、椎间孔高度及椎间隙高度方面各有优劣,医师可根据患者病情及自身情况选择合适入路进行手术。
Objective To compare the clinical and radiographic outcomes of transforaminal lumbar interbody fusion（TLIF） and posterolateral lumbar interbody fusion（PLIF） in the treatment of degenerative lumbar spondylolisthesis（DLS）. Methods From March 2008 to March 2014,the clinical data of DLS patients treated with TLIF（n=64） and PLIF（n=52） in our hospital were collected,including visual analog scale（VAS） score,Oswestry disability index（ODI）,fusion rate and the complications of iatrogenic nerve root dysfunction（INRD）,and also the degree of spondylolisthesis,lumbar lordosis angle,posterior border height of the intervertebral space and height of the intervertebral foramen. Results There was no significant difference in fusion rate and nervous function restoration between the 2 groups（P〉0.05）. There was also no significant difference in improvement of VAS score and ODI between the 2 groups（P〉0.05）. The incidence of postoperative INRD on the operation side was higher in PLIF group than that in TILF group,and the difference was statistically significant（P〈0.05）;the INRD rate on the opposite side was higher in TILF group than that in PILF group,and the difference was statistically significant（P〈0.05）. At the final follow-up,the maintenance of postoperative lumbar lordosis angle was better in TLIF group than that in PILF group,and the difference was statistically significant（P〈0.05）;the posterior border height of the intervertebral space and height of the intervertebral foramen were greater in PLIF group than those in TLIF group,and the difference was statistically significant（P〈0.05）. Conclusion The TLIF and PLIF have respective advantages in postoperative iatrogenic nerve injury incidence,local lumbar lordosis,posterior border height of the intervertebral space and height of the intervertebral foramen. According to the patient＇s and their own condition,doctors could choose the appropriate method for surgery.
出处
《脊柱外科杂志》
2017年第4期200-205,共6页
Journal of Spinal Surgery
关键词
腰椎
脊椎滑脱
脊柱融合术
Lumbar vertebrae
Spondylolysis
Spinal fusion
