Objective:To investigate the mid-term efficacy of Dynesys internal fixation and posterior lumbar interbody fusion (PLIF) in the treatment of grade I degenerative lumbar spondylolisthesis.Methods:From June 2014 to June 2016, 68 cases, in which 35 males and 33 females aged from 44-74 (55.3±7.5), of grade I degenerative lumbar spondylolisthesis treated using Dynesys internal fixation were retrospectively analyzed. There were 8 cases of L 3, 52 cases of L 4 and 8 cases of L 5 with an average visual analogue scale (VAS) of 4.5±2.1. At the same time, 72 patients were treated with posterior lumbar interbody fusion (PLIF). There were 37 males and 35 females aged from 46-76 (56.8±7.2), with 9 cases of L 3, 53 cases of L 4 and 10 cases of L 5. The VAS of this group was 4.4±2.3. The operative time, intraoperative blood loss, postoperative drainage volume and complications were compared between the two groups. Range of motion (ROM), disc height of stable segment and upper adjacent segment, adjacent segment degeneration between the two groups were evaluated. ASD, Oswestry disability index (ODI) score and Japanese Orthopaedic Association (JOA) score were also compared between the two groups. Results:The patients in both groups were followed up. The follow-up time of Dynesys group was 50-74 months, average 64.2±18.3 months, and the follow-up time of PLIF group was 55-79 months, average 65.2±15.5 months. The operation time [(120.5±21.0) min vs. (132.5±27.0) min, t=2.924, P=0.004], intraoperative bleeding [(312.5±80.7) ml vs. (352.5±84.5) ml, t=2.861, P=0.005] and postoperative drainage [(120.3±45.8) ml vs. (140.2±50.2) ml; t=2.446, P=0.016] in Dynesys group were significantly better than those in PLIF group. The differences were statistically significant. There was no significant difference in postoperative ROM of stable segment, ROM of upper segment, disc height of stable segment and adjacent segment between the two groups before operation. At 5 years postoperatively, there was statistically significant difference between the stable segment ROM (4.3°±1.6° vs. 0; t=22.809; P<0.001) and the upper segment ROM (10.5°±2.1° vs. 12.8°±2.2°; t=6.329, P<0.001). At 5 years postoperatively, ODI scores of the two groups were (11.25%±8.12%, 16.53%±9.23%), and JOA scores were (22.60±2.20, 19.01±2.34), which were significantly improved compared with those before surgery, with statistically significant differences (ODI: t=3.585, P<0.001; JOA: t=9.340, P<0.001). There was no significant difference in the incidence of symptomatic ASD between the two groups (8.8% vs. 16.7%, χ2=1.284, P=0.257) , but there was significant difference in the incidence of X-ray ASD between the two groups (2.9% vs. 13.9%, χ2=4.043, P=0.044) . Conclusion:Compared with PLIF, Dynesys internal fixation for degenerative lumbar spondylolisthesis is a minimally invasive, safe and effective surgical method to retard ASD; Compared with PLIF, adjacent segment degeneration can be reduced using Dynesys internal fixation.

目的 比较经皮椎间孔镜下腰椎管扩大减压和传统腰椎板减压、椎间融合内固定术治疗腰椎管狭窄症的疗效.方法 收集经皮椎间孔镜手术治疗的腰椎管狭窄症患者(A组)和传统开放手术患者(B组)各30例进行回顾性分析,包括患者的一般状况、术前和术后(3d及1、3、6个月)VAS评分、术前和术后(1、3、6、12个月)ODI指数、改良MacNab标准评分.结果 平均随访15.7个月,A组失访2人,B组失访5人.2组术后VAS和ODI均较术前明显降低,术后3个月及末次随访,A组腰痛VAS评分低于B组(P＜0.05),2组ODI评分差异无统计学意义(P＜0.05).结论 两种术式治疗腰椎管狭窄症均可达到满意疗效,经皮椎间孔镜手术创伤相对小,术后早期功能恢复较好;开放手术创伤相对大,但减压彻底,疗效较为肯定.

Objective To compare the clinical results of posterior lumbar interbody fusion(PLIF) between unilateral paraspinal muscular stripped approach and traditional approach in treating Lumbar disc herniation accompanied with segmental instability.Methods From January 2009 to April 2011,52 patients were reviewed.According to surgical method,all the patients were divided into two groups.The patient in group A were treated by traditional PLIF,namely the bilateral pedicle fixation plus laminectomy and lumbar interbody fusion,while the patient in group B underwent unilateral pedicle fixation and PLIF via paraspinal muscular stripped approach.VAS scale system was used to evaluate the low back pain and leg pain preoperatively and postoperatively respectively.The lumbar interbody fusion was assessed by the suk's method.Results Average follow-up was 24 months.Operation time and blood loss in group B was less than those in group A.Compared to preoperation,both the VAS of back leg pain and ODI in two groups improved significantly postoperatively.However,group B showed less back pain during the 3-month and the last follow up postoperatively.Conclusion The Uni-PLIF and PLIF can achieve satisfactory clinical outcomes in treatment of Lumbar disc herniation accompanied with segmental instability.Compared to PLIF,the Uni-PLIF has the advantage of relatively minimal invasive and less back pain of post operation as well as the early function recovery.