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目的:比较腰椎后路椎间植骨和后外侧植骨两种植骨方式在成人腰椎滑脱中的骨融合率和临床疗效。方法:对100例腰椎滑脱患者根据病情分别采取后路腰椎椎间植骨内固定(56例)和后外侧植骨融合内固定(44例)两种植骨方式。对比分析两组患者的临床资料,比较两种植骨方式的骨融合率、临床疗效、手术时间及出血量。结果:后路椎间植骨的手术时间更长,出血量更多。随访8~40个月,平均15.6个月,椎间植骨组融合率为98.21%。后外侧植骨组融合率为95.45%,两组融合率比较差异无统计学意义(P>0.05)。椎间植骨患者优良率为92.86%,后外侧植骨患者优良率为90.91%,两组优良率比较,差异无统计学意义(P>0.05)。结论:后路腰椎椎间植骨或后外侧植骨附加椎弓根内固定技术治疗腰椎滑脱均具有良好的临床效果,两种植骨方式骨融合率、临床疗效差异无统计学意义。
Abstract:Objective:To compare the treatment outcomes of posterior lumbar interbody fusion and posterolateral fusion in adult spondylolisthesis.Methods:A total of 100 adult patients(age range,36-66 years) with isthmic spondylolisthesis were divided into two groups.One group(56 cases) was treated with posterior lumbar interbody fusion and fixation,the other group was treated with posterolateral fusion and fixation.Treatment outcomes including operation duration,bleeding volume,bone fusion rate and clinical efficiency were observed and compared between the two groups.Results:Longer operation time and more bleeding volume were observed in the patients that underwent posterior lumbar interbody fusion.According to the average follow up of 15.6 months ranging from 8 months to 40 months,bone fusion rate(98.21%) for patients underwent posterior lumbar interbody fusion,and 95.45% for those had posterolateral fusion(P>0.05).Excellent or good rates were presented in 92.86% of the interbody fusion group and 90.91% in posterolateral fusion group(P>0.05).Conclusions:Both posterior lumbar interbody fusion and posterolateral fusion additional pedicle screw fixation show good outcomes in patients with lumbar spondylolisthesis with no significant difference being observed.
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基本信息:
DOI:10.13210/j.cnki.jhmu.2011.01.024
中图分类号:R687.3
引用信息:
[1]唐华军,吴强,刘建平,等.后路腰椎融合术在成人腰椎滑脱中的临床研究[J].海南医学院学报,2011,17(01):97-100.DOI:10.13210/j.cnki.jhmu.2011.01.024.
基金信息:
海南医学院科研基金资助学报项目(0020110016)~~
2010-12-31
2010-12-31
2010-12-31