【摘要】：目的：比較后路椎間融合術(shù)(PLIF、posterior lumbar interbody fusion)與后外側(cè)融合術(shù)(PLF、posterolateral fusion)治療輕度腰椎滑脫癥的臨床療效和融合率比較。方法：從2010年10月至2013年10月,在我院骨科中心,接受手術(shù)治療的總共病例數(shù)為87名,其中符合本研究納入標(biāo)準(zhǔn)的有50名輕度腰椎滑脫癥患者。PLIF組手術(shù)方式為后路椎間融合術(shù)+椎板減壓術(shù)+椎弓根螺釘內(nèi)固定術(shù)+復(fù)位術(shù)；PLF組手術(shù)方式為后外側(cè)融合術(shù)+椎板減壓術(shù)+椎弓根螺釘內(nèi)固定術(shù)+復(fù)位術(shù)。兩組患者術(shù)中應(yīng)用的植骨材料均來自于術(shù)中的椎板、棘突等自體骨。對(duì)全部患者至少進(jìn)行6個(gè)月至18個(gè)月的隨訪。兩組各有一名患者失訪。應(yīng)用融合率、術(shù)后并發(fā)癥發(fā)生率、術(shù)后ODI優(yōu)良率、住院天數(shù)、術(shù)中出血量、手術(shù)時(shí)間等指標(biāo)來對(duì)兩組患者進(jìn)行臨床療效和影像學(xué)療效的比較與評(píng)估。結(jié)果：平均隨訪時(shí)間為12個(gè)月。PLIF組患者中發(fā)生腰椎滑脫部位的分布如下：L3-4者共6名,占20%；L4-5者共15名,占50%；L5-S1者共有9名,占30%,PLF組患者中發(fā)生腰椎滑脫部位的分布如下：L3-4者共4名,占20%；L4-5者共11名,占55%；L5-S1者共有5名,占25%。PLIF組患者融合率、手術(shù)時(shí)間、并發(fā)癥發(fā)生率均高于PLF組,ODI優(yōu)良率、住院天數(shù)和術(shù)中出血量兩組患者無明顯差別。結(jié)論：PLIF組的臨床療效及影像學(xué)療效均優(yōu)于PLF組,但是PLF組的療效也是肯定的,因此我們認(rèn)為臨床上個(gè)體化設(shè)計(jì)手術(shù)治療方案時(shí)PLF也是一種重要選擇。
[Abstract]:Aim: to compare the clinical efficacy and fusion rate of posterior interbody fusion (PLIF,posterior lumbar interbody fusion) and posterolateral fusion (PLF,posterolateral fusion) in the treatment of mild lumbar spondylolisthesis. Methods: from October 2010 to October 2013, the total number of cases undergoing surgical treatment was 87 in the orthopaedic center of our hospital. Among them, 50 patients with mild lumbar spondylolisthesis were included in this study. The PLIF group was treated with posterior interbody fusion, laminar decompression and pedicle screw internal fixation. PLF group was operated by posterior lateral fusion, laminar decompression, pedicle screw fixation and reduction. The bone graft materials used in both groups were derived from the vertebral lamina, spinous process and other autogenous bones. All patients were followed up for at least 6 to 18 months. One patient in each group lost a follow-up. The clinical and imaging effects of the two groups were compared and evaluated by fusion rate, incidence of postoperative complications, excellent and good rate of postoperative ODI, length of hospital stay, intraoperative bleeding and operative time. Results: the average follow-up time was 12 months. The distribution of lumbar spondylolisthesis in PLIF group was as follows: L3-4 occurred in 6 cases, accounting for 20% and L4-5 in 15 cases, accounting for 50%; The distribution of lumbar spondylolisthesis in the L5-S1 group was as follows: L3-4 in 4, 20% in L4-5, 11 in 55%; There were 5 L5-S1 patients, which accounted for the fusion rate, operation time and complication rate of 25%.PLIF group were higher than those of PLF group, ODI excellent rate, hospitalization days and intraoperative bleeding volume had no significant difference between the two groups. Conclusion: the clinical and imaging effects of PLIF group are better than that of PLF group, but the curative effect of PLF group is also positive. Therefore, we think that PLF is also an important choice in clinical individualized design of surgical treatment scheme.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
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本文編號(hào)：2450271