两种手术方式治疗退变性腰椎滑脱症疗效比较.docVIP

两种手术方式治疗退变性腰椎滑脱症疗效比较 　 作者：申勇,张少嘉,董玉昌,丁文元,张同庆,孟宪忠,姚晓光 【摘要】 ［目的］对比椎弓根钉内固定联合单枚Cage斜形放置椎间植骨融合与椎弓根钉内固定后外侧融合治疗退变性腰椎滑脱的临床疗效。［方法］单节段退变性腰椎滑脱患者44例，按手术方式分为：Ⅰ组23例，行椎弓根器械复位固定后单枚Cage斜形放置的椎体间融合；Ⅱ组21例，行椎弓根器械复位固定后外侧融合。对两组术后JOA评分，腰腿痛VAS评分，影像学进行随访。［结果］随访15～36个月，两组间JOA评分、骨融合率无显著性差异（P＞0.05）；Ⅰ组在下腰痛缓解的VAS评分、Taillard指数、相对椎间隙高度的维持方面优于Ⅱ组（P＜0.05）。［结论］单枚融合器附加椎弓根钉的椎间植骨融合是治疗退变性腰椎滑脱更为理想的方法。 【关键词】 腰椎； 退行性滑脱； 椎体间融合； 后外侧融合 　　Clinical outcome of two operation methods in the treatment of degenerative spondylolisthesis∥ 　　Abstract：［Objective］To estimate the outcomes of two methods in the treatment of degenerative spondylolisthesis：posterior oblique lumbar arthrodeses（POLA）and posterolaterial fusion（PLF）.［Method］This retrospective study analyzed the outcome of 44 patients with single level degenerative spondylolisthesis.According to operation method,all the patients were divided in two groups:（POLA）treatment group consisted of 23 patients who had underwent laminectomy,decompression of spinal canal and posterior lumbar interbody fusion with single oblique cage supplemented pedicle screwrod fixation.（PLF）control group consisted of 21 patients who had underwent laminectomy,decompression of spinal canal and posterolateral lumbar Fusion supplemented pedicle screwrod fixation.［Result］The mean followup period for this study was 28.5 months（ranged 15～36 months）.There was no singnificant difference in fusion rate and clinical outcome according to the JOA scores system between two groups（P＞0.05）;the better result was obtained including low back pain,Taillard index and relative disc height at the end of followup in POLA.［Conclusion］Posterior oblique lumbar arthrodeses is better ideal method in the treatment of degenerative spondylolisthesis. 　　Key words：lumbar; degenerative spondylolisthesis; posterior interbody fusion; posterolateral fusion 　　退变性腰椎滑脱多介于Ⅰ～Ⅱ度之间，部分患者具有骨赘形成，椎间隙变窄等再稳定的因素，在治疗术式的选择上，行椎弓根钉器械复位固定后单枚Cage斜形放置的椎体间融合（posterior oblique lumbar arthrodeses,POLA）与后外侧融合的（posterolateral lumbar fusion,PLF）