Dou Yusheng, Hao Dingjun, Wen Shiming, He Baorong
Department of Orthopaedics, the Red Cross Hospital of Xi'an, Xi' an Shaanxi, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006 Jul;20(7):743-6.
To compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) using simple cage alone fusion with pedicle screw fixation and autogenous bone grafting and cage fusion with pedicle screw fixation in adult spondylolisthesis.
From March 2003 to March 2004, twenty-seven patients with lumbar spondylolisthesis were divided in two groups. In group A, 15 patients were treated by PLIF using simple cage alone fusion with pedicle screw fixation, including 4 males and 11 females, aging 53-68 years. Isthmic defects were located at L4 in 9 cases, at L5 in 6 cases. Four patients were smokers. The preoperative mean disc space height was 5.4 +/- 2.3 mm, the mean percentage of slip was 36.8% +/- 7.2%. In group B, 12 patients were treated by PLIF using autogenous bone grafting and cage fusion with pedicle screw fixation, including 3 males and 9 females, aging 56 years. Isthmic defects were located at L4 in 8 cases, at L5 in 4 cases. Five patients were smokers. The preoperative mean disc space height was 5.7 +/- 2.5 mm, the mean percentage of slip was 37.8% +/- 6.2%. Two groups were compared in the amount of blood loss, duration of hospitalization, back pain, radiating pain, fusion rate, the intervertebral disc space height, the postoperative degree of slip and the fusion rate.
All patients were followed up for 24-38 months. The mean follow-up was 29 (24-36) months in group A and 26 (24-38) months in group B. There were no statistically significant differences in follow-up period, age, sex, the location of isthmic defects, smoking, the preoperative disc space height and the percentage of slip between two groups (P > 0.05). There were no statistically significant differences in the amount of blood loss, the duration of hospitalization, the fusion time between two groups (P > 0.05). But there were statistically significant differences in the back pain score, the radiating pain score and the fusion rate between two groups (P < 0.05). The postoperative disc space height and the degree of slip of the last follow-up were 5.8 +/- 2.2 mm and 25.6% +/- 7.2% in group A, 6.2 +/- 2.5 mm and 24.1% +/- 7.4 % in group B, showing statistically significant difference (P < 0.05).
The PLIF using autogenous bone grafting and cage fusion with pedicle screw fixations is more beneficial to improving the fusion rate and preventing longterm instabilities than simple cage alone fusion with pedicle screw fixation in adult spondylolisthesis.
比较单纯椎间融合器融合联合椎弓根螺钉固定及自体骨移植与椎间融合器融合联合椎弓根螺钉固定在成人腰椎滑脱症后路腰椎椎间融合术（PLIF）中的临床疗效。
2003年3月至2004年3月，将27例腰椎滑脱症患者分为两组。A组15例患者采用单纯椎间融合器融合联合椎弓根螺钉固定行PLIF治疗，其中男性4例，女性11例，年龄53 - 68岁。峡部裂缺损位于L4者9例，位于L5者6例。4例患者为吸烟者。术前平均椎间隙高度为5.4±2.3mm，平均滑脱百分比为36.8%±7.2%。B组12例患者采用自体骨移植联合椎间融合器融合及椎弓根螺钉固定行PLIF治疗，其中男性3例，女性9例，年龄56岁。峡部裂缺损位于L4者8例，位于L5者4例。5例患者为吸烟者。术前平均椎间隙高度为5.7±2.5mm，平均滑脱百分比为37.8%±6.2%。比较两组患者的失血量、住院时间、背痛、放射痛、融合率、椎间隙高度、术后滑脱程度及融合率。
所有患者均随访24 - 38个月。A组平均随访时间为29（24 - 36）个月，B组为26（24 - 38）个月。两组在随访时间、年龄、性别、峡部裂缺损位置、吸烟情况、术前椎间隙高度及滑脱百分比方面差异无统计学意义（P > 0.05）。两组在失血量、住院时间、融合时间方面差异无统计学意义（P > 0.05）。但两组在背痛评分、放射痛评分及融合率方面差异有统计学意义（P < 0.05）。末次随访时，A组术后椎间隙高度及滑脱程度分别为5.8±2.2mm和25.6%±7.2%，B组分别为6.2±2.5mm和24.1%±7.4%，差异有统计学意义（P < 0.05）。
在成人腰椎滑脱症中，自体骨移植联合椎间融合器融合及椎弓根螺钉固定的PLIF术比单纯椎间融合器融合联合椎弓根螺钉固定更有利于提高融合率及预防远期不稳定。
