CAJ | 학술논문

背景：近年，临床上采用椎弓根内固定、椎管减压及植骨融合联合治疗退变性腰椎滑脱合并腰椎管狭窄症取得了良好的效果，增加了融合率，但不同手术方式的治疗效果差异很大。目的：对比经后路与经椎间孔植骨融合修复退变性腰椎滑脱并发腰椎管狭窄症的效果。方法：纳入40例退变性腰椎滑脱并发腰椎管狭窄症患者，其中男11例，女29例，年龄56-74岁，均接受椎弓根内固定、椎管减压及植骨融合联合治疗，其中19例选择经后路椎体间融合，21例选择经椎间孔椎体间融合，植骨材料均为多孔β-磷酸三钙。治疗后随访6个月，对比两组目测类比评分、Oswestry 功能不良指数评分、植骨融合率、腰椎功能评分及并发症发生情况。结果与结论：治疗后6个月，两组目测类比评分、Oswestry功能不良指数评分均较治疗前明显改善(P <0.05)，两组间植骨融合率、目测类比评分、Oswestry功能不良指数评分比较差异无显著性意义；经椎间孔椎体间融合组的腰椎功能恢复好于经后路椎体间融合组(P <0.05)，硬脑膜囊破裂、神经根损伤等并发症的发生率低于经后路椎体间融合组(P <0.05)。表明经后路与经椎间孔植骨融合修复退变性腰椎滑脱并发腰椎管狭窄症均具有良好的植骨融合率，但经椎间孔植骨融合更有利于保护神经根及硬膜囊、促进腰椎功能恢复。
배경：근년，림상상채용추궁근내고정、추관감압급식골융합연합치료퇴변성요추활탈합병요추관협착증취득료량호적효과，증가료융합솔，단불동수술방식적치료효과차이흔대。목적：대비경후로여경추간공식골융합수복퇴변성요추활탈병발요추관협착증적효과。방법：납입40례퇴변성요추활탈병발요추관협착증환자，기중남11례，녀29례，년령56-74세，균접수추궁근내고정、추관감압급식골융합연합치료，기중19례선택경후로추체간융합，21례선택경추간공추체간융합，식골재료균위다공β-린산삼개。치료후수방6개월，대비량조목측류비평분、Oswestry 공능불량지수평분、식골융합솔、요추공능평분급병발증발생정황。결과여결론：치료후6개월，량조목측류비평분、Oswestry공능불량지수평분균교치료전명현개선(P <0.05)，량조간식골융합솔、목측류비평분、Oswestry공능불량지수평분비교차이무현저성의의；경추간공추체간융합조적요추공능회복호우경후로추체간융합조(P <0.05)，경뇌막낭파렬、신경근손상등병발증적발생솔저우경후로추체간융합조(P <0.05)。표명경후로여경추간공식골융합수복퇴변성요추활탈병발요추관협착증균구유량호적식골융합솔，단경추간공식골융합경유리우보호신경근급경막낭、촉진요추공능회복。
BACKGROUND:In recent years, pedicle internal fixation, spinal canal decompression and bone graft fusion have been used in the treatment of degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis and have achieved good results, which increase the fusion rate. However, there is a large difference between the therapeutic effects of different surgical methods. OBJECTIVE:To contrast the repair effect of posterior and transforaminal lumbar interbody fusion on degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis. METHODS:Forty patients with degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis were enroled, including 11 males and 29 females, aged 56-74 years. Al patients received the combined treatment of pedicle internal fixation, spinal canal decompression and bone graft fusion. The 19 of 40 patients received posterior lumbar interbody fusion and the rest 21 patients underwent transforaminal lumbar interbody fusion. Al the patients were folowed up for 6 months after treatment, and the visual analog scores, Oswestry function index, bone fusion rate, lumbar function score and complication occurrence were analyzed and <br> compared between the two groups. RESULTS AND CONCLUSION:The visual analog scores and Oswestry function index were both improved significantly in the two groups at 6 months after treatment (P < 0.05). No difference was found in the bone fusion rate, visual analog scores and Oswestry function index between the two groups. But compared with the posterior lumbar interbody fusion group, the lumbar functional recovery and incidence of complications were better in the transforaminal lumbar interbody fusion group (P < 0.05). These findings indicate that both posterior and transforaminal lumbar interbody fusions for degenerative lumbar spondylolisthesis complicated by lumbar spinal stenosis can achieve good results in the bone fusion rate, and however, the transforaminal lumbar interbody fusion is better to protect the nerve root and dural sac and to promote lumbar functional recovery.