腰椎融合术课件.ppt

* 华中科技大同济医学院附属协和医院骨科 腰椎融合术： 后外侧融合（PLF） OR 腰椎椎间融合（LIF）? 腰 椎 融 合 术 Lumbar fusion —— 重建腰椎稳定性 适应症主要包括椎间盘源性腰背痛、腰椎滑脱、节段不稳、结核、肿瘤、创伤及腰椎二次手术 常用的腰椎融合方式： 后外侧融合 （posterolateral fusion，PLF） 腰椎椎间融合（lumbar interbody fusion，LIF） ALIT,TLIF, PLIF ……1911?年问世 …… Hibbs 实施了第1 例脊柱融合术，术中取自体棘突作为植骨材料植于椎板间达到植骨融合的目的—— 后侧融合术 （现已基本淘汰） 后外侧融合 (PLF)与腰椎椎间融合(LIF) —— 那种方式更好？？？ 采用循证医学研究方法，评价PLF与LIF 的疗效 Medline 搜索“ lumbar fusion”文献， 通过浏览文题及摘要初筛文献，然后通过阅读全文，进一步筛选符合研究标准的文献，最后15篇全文文献纳入我们的分析研究中 Spine Euro Spine Neurosurg Spine Z. Lidar et al. / Surgical Neurology 64 (2005) 303–308 No differences in clinical and functional outcomes were found between the groups Fusion rate for the entire PLIF group was 97.7% (44/45). Fusion rate for the entire PLF group was 89.6% (52/58). Subdividing the groups into 1- and 2-level fusions, Fusion rate for 1-level PLIF was 100% (30/30) and 93.3% (14/15) for 2-level fusion. Fusion rate for 1-level PLF was 95% (19/20) and 87.5% (21/24) for 2-level fusion Conclusion: There were no significant differences in fusion rate of 1-/2-level PLIF vs PLF. although a higher fusion tendency was observed in the PLIF group 24 months fellow-up 1. Low back pain There were no significant differences in outcome of PLIF vs PLF groups. Tina S. Videbaek, et al. SPINE Volume XX, ?2010 148 patients with severe chronic low back pain were randomly selected for posterolateral lumbar fusion plus anterior support (PLF ALIF) or posterolateral lumbar fusion. 2. Y. Wu et al. / Journal of Clinical Neuroscience 18 (2011) 780–783 Complications: nerve root injury, dural tears 3. Kristian H?y, et al. April 2013, Eur Spine J TLIF PLF Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either TLIF or PLF. 4. 5. Z. Zhou et al. J