加压植骨联合单枚Cage的椎体间融合与后外侧融合治疗双节段腰椎椎管狭窄症临床效果的回顾性研究

摘要

目的 探讨双节段腰椎椎管狭窄症后路减压手术后行椎间加压植骨联合单枚Cage置入的椎体间融合术(posterior lumbar interbody fusion,PLIF)与后外侧融合术(posterolateral fusion,PLF)的临床效果.方法 回顾性随访分析53例双节段腰椎椎管狭窄症行后路椎管减压、融合手术的患者,分为2组,PLF组31例,PLIF组22例.对2组患者手术情况进行比较,手术前、后及末次随访进行日本骨科协会(Japanese Orthopaedic Association,JOA)评分及下腰痛的视觉模拟量表(visual analog scale,VAS)评分.结果 2组手术时间差异有统计学意义(P<0.05);出血量、输血量差异无统计学意义(P>0.05);JOA评分,手术前2组差异无统计学意义(P>0.05),术后2组差异有统计学意义(P<0.05);术后2组下腰背疼痛的VAS评分差异有统计学意义(P<0.01).结论 椎弓根螺钉内固定椎间加压植骨联合单枚Cage置入椎体间融合术较后外侧融合效果肯定,手术方式安全,手术后恢复快,出现下腰疼痛病例少,融合率高.%Objective To compare the clinical effects between posterior lumbar interbody fusion ( PLIF ) and posterolateral fusion ( PLF ) with single Cage implantation in the treatment of double segments lumbar spinal stenosis. Methods From January 2006 to December 2009, a total of 53 patients with double segments lumbar spinal stenosis, who received posterior lateral decompression and interbody fusion operation were divided into 2 groups: one was Group PLF, containing 31 patients, and the other was Group PLIF, containing 22 patients. And their clinical data and outcomes were analyzed retrospectively. Japanese Orthopaedic Association ( JOA ) score and visual analogue scale ( VAS ) score for lower back pain were performed preoperatively, postoperatively and at the final follow-up. Radiology was carried out at the first week, third months, sixth months and twelfth months postoperatively. Results There was significant difference in operation time ( P < 0.05 ), but not in blood loss and transfusion between the 2 groups ( P >0. 05 ). No difference was found in JOA score preoperatively ( P >0.05 ), but significant difference was seen postoperatively between the 2 groups ( P <0. 05 ). For lower back pain VAS score, statistically significant difference was found between the 2 groups at the final follow-up ( P < 0.01 ), with that of Group PLIF significantly lower. Conclusion PLIF with intervertebral pressured bone graft combined with single Cage implantation has better fusion outcomes compared with PLF. Besides, PLIF can provide safer operation, faster postoperative recovery, less lower back pain and higher fusion rate than PLF.