Kim Sang-Il, Ha Kee-Yong, Kim Young-Hoon, Kim Young-Ho, Oh In-Soo
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea.
Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Indian J Orthop. 2018 Jul-Aug;52(4):358-362. doi: 10.4103/ortho.IJOrtho_330_16.
For Grade I degenerative lumbar spondylolisthesis (DLS), both decompression alone and decompression with fusion are effective surgical treatments. Which of the two techniques is superior is still under debate. The purpose of this study was to compare clinical outcomes after decompression alone versus decompression with fusion for Grade I DLS.
139 patients who underwent surgery for Grade I DLS at L4-L5 were prospectively enrolled. Decompression alone was used to treat 74 patients, and decompression with fusion was used to treat 65 patients. Six patients in the first group and four patients in the second group were lost during the 2-year followup. Demographic data were recorded. Operation time, perioperative blood loss, total blood transfusion volume, and length of hospital stay were compared between the two groups. Back pain and functional outcomes were evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively.
Baseline demographic data were not different between the two groups. Operation time, blood loss, total blood transfusion volume, and length of hospital stay were all significantly greater in the fusion group than in the decompression group. This would be expected because fusion is the more invasive procedure. VAS scores were not different up until 6 months postoperatively. Twelve months after surgery, however, VAS scores were significantly lower in the fusion group. The same results were shown in terms of ODI. Although ODI decreased in both groups over time, the fusion group showed better functional outcomes than did the decompression group.
Although both decompression alone and decompression with fusion improved functional outcomes for Grade I DLS, fusion surgery resulted in better results compared to decompression alone. Therefore, fusion should be considered as the treatment of choice for Grade I DLS.
对于I度退行性腰椎滑脱症（DLS），单纯减压和减压融合术都是有效的手术治疗方法。这两种技术哪种更具优势仍存在争议。本研究的目的是比较I度DLS单纯减压与减压融合术后的临床疗效。
前瞻性纳入139例行L4-L5节段I度DLS手术的患者。74例患者采用单纯减压治疗，65例患者采用减压融合术治疗。在2年的随访期间，第一组有6例患者失访，第二组有4例患者失访。记录人口统计学数据。比较两组的手术时间、围手术期失血量、总输血量和住院时间。分别采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评估背痛和功能结局。
两组的基线人口统计学数据无差异。融合组的手术时间、失血量、总输血量和住院时间均显著高于减压组。这是预期的结果，因为融合术是侵入性更强的手术。术后6个月内VAS评分无差异。然而，术后12个月，融合组的VAS评分显著更低。ODI方面也显示出相同的结果。尽管两组的ODI均随时间下降，但融合组的功能结局优于减压组。
虽然单纯减压和减压融合术均改善了I度DLS的功能结局，但与单纯减压相比，融合手术的效果更好。因此，融合术应被视为I度DLS的首选治疗方法。
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