Curative effect and imaging effect of PLF on patients with lumbar spondylolisthesis
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摘要:
目的探讨后外侧植骨融合术（PLF）在治疗腰椎滑脱症患者中的临床效果。 方法回顾性研究我院骨科收治的118例腰椎滑脱症患者，其中58例患者采用PLF联合椎弓根螺钉内固定手术治疗（PLF组）、60例患者采用后路椎间植骨融合术（PLIF）联合椎弓根螺钉内固定手术治疗（PLIF组）；统计分析两组的手术时间、手术出血量以及采用X线、CT等手段测量植骨融合率、并发症率、手术前后日本骨科协会评估治疗(JOA评分)、椎间隙高度、椎体滑脱率等。 结果PLF组和PLIF组患者的手术时间、手术出血量差异无统计学意义（P>0.05）；PLF组的植骨融合率低于PLIF组患者（84.48% vs 96.67% P < 0.05）；术前PLF组和PLIF组患者的JOA评分、椎间隙高度、椎体滑脱率差异无统计学意义（P>0.05）；术后1年PLF组的JOA评分低于PLIF组患者的96.67%（P < 0.05），PLF组患者的椎体滑脱率高于PLIF组（P < 0.05）；术后1月、术后1年，PLF组的椎间隙高度均低于PLIF组（P < 0.05）；PLF组的手术并发症率（6.90%）与PLIF组患者（3.33%）的差异无统计学意义（P>0.05）。 结论腰椎滑脱症患者采用PLF与PLIF治疗效果均较好，PLIF手术较PLF手术更有利于维持术后腰椎功能恢复、维持椎间隙高度、减少术后椎体滑脱的发生率。 Abstract:ObjectiveTo explore the clinical effect of posterolateral bone graft fusion (PLF) in the treatment of patients with lumbar spondylolisthesis. MethodsA retrospective study of 118 patients with lumbar spondylolisthesis was conducted in our hospital's Orthopedics Department. Among them, 58 patients were treated with PLF combined with pedicle screw internal fixation (PLF group), and 60 patients were treated with posterior interbody fusion (PLIF) along with pedicle screw internal fixation surgery (PLIF group). Operation time, surgical bleeding volume, bone graft fusion rate using X lines, CT, complications rate, JOA score before and after the operation, intervertebral space height, vertebral body slippage rate, ect. were statistically analyzed in two groups. ResultsThere was no statistically significant difference in operation time, the amount of bleeding, JOA score intervertebral space height, and vertebral spondylolisthesis rate between the PLF group and the PLIF group (P>0.05); the bone graft fusion rate in the PLF group was 84.48% lower than the 96.67% in the PLIF group (P < 0.05); The surgical complication rate had no significant different with 6.90% of PLF group and 3.33% of PLIF group.1 year after operation, JOA score in PLF group was lower than 96.67% in PLIF group (P < 0.05), the vertebral spondylolisthesis rate of patients in PLF group was higher than that of PLIF group (P < 0.05); the height of intervertebral space in PLF group was lower than that of PLIF group 1 month and 1 year after surgery (P < 0.05). ConclusionPLF and PLIF are both good treatment for lumbar spondylolisthesis. PLIF surgery is more beneficial to maintain postoperative lumbar spine function recovery, intervertebral space height, and reduce the incidence of postoperative vertebral spondylolisthesis. -
图 1 患者男，61岁，腰椎滑脱腰椎间盘突出症，完善影像学检查后确定为腰5椎体Ⅱ度滑脱
A:术前X线正侧位; B:过伸过屈位X线; C: CT冠状位扫描; D: CT平扫患者采用PLIF联合椎弓根螺钉内固定手术治疗; E~F:术后1月X线复查结果.
Figure 1. A 61-year-old male with lumbar spondylolisthesis of the lumbar intervertebral disc. After complete imaging examination, it was determined that the lumbar 5 vertebral body spondylolisthesis
图 2 患者女，73岁，腰椎滑脱入院，完善影像学检查后确定为腰5椎体Ⅰ度滑脱
A:术前X线正侧位; B:过伸过屈位X线; C: CT冠状位扫描; D: CT平扫患者采用PLF联合椎弓根螺钉内固定手术治疗; E~F:术后1月X线复查结果.
Figure 2. A female patient was 73 years old and was admitted to the hospital with lumbar spondylolisthesis. After complete imaging examination, it was determined that the lumbar 5 vertebral body was spondylolisthesis.
表 1 两组患者手术相关指标比较
Table 1. Comparison of surgery-related indexes between the two groups
组别 手术时间（min, Mean±SD） 手术出血量（mL, Mean±SD） 植骨融合率[n(%)] PLF组（n=58） 180.6±15.8 676.8±89.4 49(84.48) PLIF组（n=60） 183.2±18.6 688.1±95.2 58(96.67) t/χ2 -0.817 -0.664 5.179 P 0.416 0.508 0.023 
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表 2 两组患者手术前后的JOA评分、椎间隙高度、椎体滑脱率比较
Table 2. Comparison of JOA score, intervertebral space height, and vertebral spondylolisthesis before and after operation in two groups (Mean±SD)
指标 术前 术后1月 术后1年 JOA评分（分） PLF组（n=58） 16.33±2.75 21.76±3.20 24.37±2.85 PLIF组（n=60） 15.97±2.60 22.61±2.94 25.78±2.67 t 0.731 -1.503 -2.774 P 0.466 0.135 0.006 椎间隙高度（mm） PLF组（n=58） 6.83±1.50 10.82±2.41 10.78±2.67 PLIF组（n=60） 6.60±1.48 14.11±2.79 13.85±2.60 t 0.838 -6.845 -6.328 P 0.404 0.000 0.000 椎体滑脱率（%） PLF组（n=58） 34.72±5.04 14.69±2.80 16.00±2.77 PLIF组（n=60） 34.26±4.98 13.88±2.69 14.21±2.51 t 0.499 1.603 3.681 P 0.619 0.112 0.000
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表 3 两组患者手术并发症率率比较
Table 3. Comparison of the rate of surgical complications between the two groups (n)
组别 切口感染 下肢深静脉血栓 泌尿系统感染 并发症率[n(%)] PLF组（n=58） 1 1 2 4(6.90) PLIF组（n=60） 0 1 1 2(3.33) χ2 - - - 0.776 P - - - 0.378
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