方法:随机对照试验。
目的:比较后外侧融合术(PLF)和后路腰椎椎间融合术(PLIF)对低级别峡部裂性腰椎滑脱患者矢状面影像学参数的影响。此外,探讨这些参数的变化与临床结局之间的相关性。
方法:最初纳入46例连续的单级别低级别峡部裂性腰椎滑脱患者。他们被随机分配接受PLF或PLIF。患者随访至少24个月。影像学结果包括骨盆发病率,骨盆倾斜,骶骨斜坡,腰椎前凸,矢状垂直轴,T1骨盆角,滑移角,滑移度和盘高度。通过Oswestry残疾指数(ODI)和视觉模拟评分(VAS)评估临床结果。
结果:4名参与者失访。在剩下的42名患者中,29个女人PLF组平均年龄为40.23±10.25岁,PLIF组平均年龄为35.81±10.58岁。PLIF组的所有影像学参数的校正具有统计学意义。两组的ODI和VAS均有显著改善,两组之间无显著差异。ODI和VAS的变化与椎间盘高度的变化显着相关,滑移角和腰椎前凸。
结论:在低级别峡部裂性腰椎滑脱患者中,与PLF相比,PLIF在校正矢状射线照相参数方面表现出更好的疗效。然而,这种区别似乎并不影响短期临床结果.恢复光盘高度,校正滑移角,重建正常的腰椎前凸是峡部裂性腰椎滑脱手术治疗的关键步骤。
METHODS: Randomized controlled trial.
OBJECTIVE: To compare the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on sagittal radiographic parameters in patients with low-grade isthmic spondylolisthesis. Additionally, to explore the correlation between changes in these parameters and clinical outcomes.
METHODS: Forty-six consecutive patients with single-level low-grade isthmic spondylolisthesis were initially enrolled. They were randomly assigned to undergo either PLF or PLIF. Patients were followed up for at least 24 months. Radiographic outcomes included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, sagittal vertical axis, T1 pelvic angle, slip angle, slip degree and disc height. Clinical outcomes were assessed by the Oswestry Disability Index (ODI) and visual analogue scale (VAS).
RESULTS: Four participants were lost to follow-up. Of the remaining 42 patients, 29 were female. The mean age was 40.23 ± 10.25 years in the PLF group and 35.81 ± 10.58 years in the PLIF group. There was a statistically significant greater correction of all radiographic parameters in the PLIF group. The ODI and VAS improved significantly in both groups, with no significant differences between the two groups. Changes in the ODI and VAS were significantly correlated with changes in disc height, slip angle and lumbar lordosis.
CONCLUSIONS: In patients with low-grade isthmic spondylolisthesis, PLIF demonstrates superior efficacy compared to PLF in correcting sagittal radiographic parameters. Nevertheless, this distinction does not seem to influence short-term clinical results. Restoring disc height, correcting the slip angle, and reestablishing normal lumbar lordosis are crucial steps in the surgical management of isthmic spondylolisthesis.