Hou Hai-Tao, Wang Ya-Nan, Shao Shi-Ze, Huang Xiang-Peng
Department of Spinal Cord, Wendeng Orthopaedic Hospital, Wendeng 264400, Shangdong, China;
Department of Spinal Cord, Wendeng Orthopaedic Hospital, Wendeng 264400, Shangdong, China.
Zhongguo Gu Shang. 2017 Feb 25;30(2):169-174. doi: 10.3969/j.issn.1003-0034.2017.02.015.
To compare the clinical effects of isthmic spondylolisthesis by a single cage or double cages interbody fusion combined with pedicle screw fixation.
The clinical data of 172 patients with isthmic spondylolisthesis underwent surgery from March 2000 to August 2008 were retrospectively analyzed. All cases underwent posterior pedicle screw fixation and interbody fusion, 89 cases with single cage fusion and 83 cases with double cages fusion. In single cage group, there were 56 males and 33 females, aged from 18 to 63 years old with an average of(41.60±8.20) years;25 cases were in L4 segment and 64 cases were in L5;according to the Meyerding standard, 32 cases were I degree, 46 cases were II degree and 11 cases were III degree. In double cage group, there were 49 males and 34 females, aged from 20 to 65 years old with an average of(43.30±6.39) years;21 cases were in L4 and 62 cases were in L5;according to the Meyerding standard, 25 cases were I degrees, 45 cases were II degree, and 13 cases were III degree. The operative time, intraoperative blood loss, postoperative drainage volum, bone fusion rate, intervertebral space height and the improvement of clinical symptoms were compared between two groups.
All the operations were successful and all patients were followed up for 18 to 83 months with an average of 4 years and 3 months. The operative time, intraoperative blood loss, postoperative drainage volume in single cage group were less than of double cage group(<0.05). Two weeks after operation, the intervertebral space height was significantly increased in two groups(<0.05), and there was no significant difference at the last follow-up between two groups. At 16 months after operation, all bone grafts of patients got bony fusion by X-rays. At the last follow-up, there were no statistically significant difference in JOA, ODI and VAS score between two groups, no pedicle screw loosening and breaking were found.
Single cage interbody fusion combined with pedicle screw fixation is as effective as with double cages interbody fusion in treatment of isthmic spondylolisthesis, it has the advantages of short operative time and less blood loss.
比较单节段椎间融合器或双节段椎间融合器联合椎弓根螺钉内固定治疗峡部裂型腰椎滑脱症的临床疗效。
回顾性分析2000年3月至2008年8月行手术治疗的172例峡部裂型腰椎滑脱症患者的临床资料。所有病例均行后路椎弓根螺钉内固定及椎间融合术，其中单节段椎间融合器融合89例，双节段椎间融合器融合83例。单节段椎间融合器组男56例，女33例，年龄18～63岁，平均（41.60±8.20）岁；L4节段25例，L5节段64例；按Meyerding标准，Ⅰ度32例，Ⅱ度46例，Ⅲ度11例。双节段椎间融合器组男49例，女34例，年龄20～65岁，平均（43.30±6.39）岁；L4节段21例，L5节段62例；按Meyerding标准，Ⅰ度25例，Ⅱ度45例，Ⅲ度13例。比较两组手术时间、术中出血量、术后引流量、骨融合率、椎间隙高度及临床症状改善情况。
所有手术均获成功，所有患者均随访18～83个月，平均4年3个月。单节段椎间融合器组手术时间、术中出血量、术后引流量均少于双节段椎间融合器组（P<0.05）。术后2周，两组椎间隙高度均明显增加（P<0.05），末次随访时两组比较差异无统计学意义。术后16个月，X线片示所有患者植骨均获骨性融合。末次随访时，两组JOA、ODI及VAS评分比较差异无统计学意义，未发现椎弓根螺钉松动及断裂。
单节段椎间融合器联合椎弓根螺钉内固定治疗峡部裂型腰椎滑脱症与双节段椎间融合器联合椎弓根螺钉内固定疗效相当，且具有手术时间短、出血量少的优点。
