后路椎间融合及经椎间孔入路椎间融合治疗伴椎弓断裂的退变性腰椎滑脱症的临床效果比较

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摘要目的探讨后路椎间融合及经椎间孔入路椎间融合治疗伴椎弓断裂的退变性腰椎滑脱症的临床疗效。方法回顾性分析2011年1月～2015年12月东台市人民医院骨科收治的120例伴椎弓断裂的退变性腰椎滑脱症患者的临床资料，按手术方法不同分为两组，其中60例采用后路椎间融合为对照组，60例采用经椎间孔入路椎间融合为观察组。比较两组手术时间、住院费用、术中出血量；术后随访1年，比较两组JOA评分，定期复查X线片，观察融合情况及腰椎稳定性。结果观察组手术时间、术中出血量和住院费用均低于对照组，差异有统计学意义（P < 0.05）。两组术后OD指数均低于术前，且观察组低于对照组，差异有统计学意义（P < 0.05）。两组融合率差异无统计学意义（P > 0.05）。两组随访期间椎体活动度和透亮带宽度差异无统计学意义（P > 0.05），而椎间隙平均高度对照组低于观察组，差异有统计学意义（P < 0.05）。对照组2例出现脑脊液漏，与术中分离瘢痕粘连有关，术后予头低脚高位，症状缓解。随访期间未出现无融合器移位、下沉及钉棒松动、断裂发生。两组均未出现感染。结论经椎间孔入路椎间融合在伴有椎弓峡部裂的腰椎滑脱症患者中创伤小、复位理想、临床疗效满意，腰椎稳定性好，骨性融合率高，值得临床推广应用。

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	侯刚1 王四清2▲ 孙达峰2 路晓1 周金军1

关键词 ：椎间融合, 椎间孔, 椎弓断裂, 腰椎滑脱症

Abstract：Objective To investigate the clinical effect of posterior interbody fusion and intervertebral foramen fusion in the treatment of degenerative lumbar spondylolisthesis with vertebral fracture. Methods From January 2011 to December 2015, in Department of Orthopedics, Dongtai People's Hospital, the clinical data of 120 patients with vertebral fracture degeneration lumbar spondy lolisthesis were analyzed retrospectively. according to the operation method they were divided into observation group and control group, 60 cases with posterior interbody fusion were as control group, and 60 cases with intervertebral foremen fusion were as observation group. The operative time, hospitalization cost and intraoperative blood loss of the two groups were compared. 1 year after operation, the JOA scores were compared, the X-ray films were regularly reviewed to observe the fusion and lumbar stability. Results The operation time, intraoperative blood loss and hospitalization cost were in the observation group lower than those in the control group, the differences were statistically significant (P < 0.05). The ODI of the observation group was lower than that of the control group, the difference was statistically significant (P <0.05). There was no significant difference of fusion rate between the two groups (P > 0.05). There was no significant difference in vertebral activity and translucent band width between the two groups (P > 0.05), but the average height of the intervertebral space of control group was lower than that of the observation group, the difference was statistically significant (P <0.05). In the control group, there were 2 cases of cerebrospinal fluid leakage, which was related to the separation of scar adhesions during operation. During the follow-up, there was no dislocation of the fusion, sinking and nail bar loosening, and the fracture occurred. No infection in both groups. Conclusion Intervertebral forumen fusion is superior to lumbar spondylolisthesis in patients with lumbar spondylolisthesis. The clinical effect is satisfactory, the stability of lumbar vertebra is good and the fusion rate is high. It is worthy of clinical application.

Key words： Intervertebral fusion Intervertebral foramen Pedicle fracture Lumbar spondy lolisthesis

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引用本文:

侯刚1 王四清2▲ 孙达峰2 路晓1 周金军1. 后路椎间融合及经椎间孔入路椎间融合治疗伴椎弓断裂的退变性腰椎滑脱症的临床效果比较[J]. 中国医药导报, 2017, 14(18): 94-97.
HOU Gang1 WANG Siqing2▲ SUN Dafeng2 LU Xiao1 ZHOU Jinjun1. Posterior interbody fusion and intervertebral foramen fusion therapy comparison of clinical curative effect of degenerative lumbar spondylolisthesis with vertebral fracture. 中国医药导报, 2017, 14(18): 94-97.

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