| Objective To formulate the surgical plan more reasonable and effective in the treatment of the elderly patients with degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis,two groups of elderly patients with degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis were treated by using TLIF and PLIF operation respectively and the clinical efficacy of the two kinds of operation was compared.Methods A total of 48 cases of elderly patients with degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis who came to the Department of orthopedics in our hospital from June 2010 to May 2015 were chosen as the research object.All the patients were consistent with the diagnostic criteria of degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis,and were checked by lumbar CT or MRI imaging examination to confirm the diagnosis.All the 48 cases were divided into two groups according to the different surgical methods,and 24 cases in each group,the TLIF group was treated with TLIF,and the PLIF group was treated with PLIF.The operation time,blood loss,postoperative drainage volume,and postoperative bed time was compared between the two groups.After the operation,the patients were monitored to compare the two groups of patients with interbody fusion success rate,efficacy,spondylolisthesis correction,pain and function and complications.Using statistical software SPSS19.0 to analyze the data.Results 1.A total of 48 cases of the elderly patients with degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis were divided into two groups according to the different surgical methods.The age,sex,disease vertebral segment and lumbar spondylolisthesis degree of the two groups of patients were compared and there was no significant statistical difference(P > 0.05).2.After the end of surgery,the surgical condition of the two groups,including operation time,intraoperative bleeding volume,postoperative drainage volume and postoperative bed time indicators was analyzed.The operative time of TLIF group was(107.2 ± 16.4)min,the operative time of the PLIF group was(123.5 ± 16.1)min,the difference was statistically significant(P < 0.05).The intraoperative bleeding of TLIF group was(151.3 ± 69.2)m L,the intraoperative bleeding of PLIF group was(259.7 ± 68.7)m L,the difference was statistically significant(P < 0.05).Postoperative drainage of TLIF group was(164.2 ± 55.2)m L,postoperative drainage of PLIF group was(216.3 ± 54.8)m L,the difference was statistically significant(P < 0.05).The postoperative bed time of TLIF group was(2.21 ± 0.96)d and the postoperative bed time of PLIF group was(4.54 ± 1.03)d,the difference was statistically significant(P < 0.05).The results show that the duration of TLIF surgery was shorter than that of PLIF surgery,and operative bleeding and postoperative drainage of TLIF surgery were less than that of PLIF surgery,patients with postoperative bed time was shorter than PLIF.3.The clinical effect and success rate of interbody fusion after operation was compared of the two groups.The excellent rate of the clinical effect of the TLIF group was 91.7% and it was significantly higher than that of PLIF group(62.5%)(P < 0.05).The success rate of interbody fusion in PLIF group was significantly higher than that of the TLIF group.The difference was statistically significant(P < 0.05).4.The spondylolisthesis degree before treatment of the TLIF group was(46.7 ± 6.3)%,and that of the PLIF group was(46.4 ± 5.9)%.There was no significant difference between the two groups(P > 0.05).When the patients in the two groups were treated by the two surgeries respectively,the spondylolisthesis degree of the TLIF group was(13.4 ± 5.8)%,and that of the PLIF group was(17.7 ± 6.1)%.There was significant difference of the two groups of patients with spondylolisthesis degreebefore and after the two surgeries respectively.However,there was no significant difference between the two groups after surgery(P > 0.05).These results showed that the two kinds of surgery can be very good to correct the lumbar spondylolisthesis.As there was no significant difference in the two groups after the operation,the effect of the two surgical methods on the improvement of the degree of spondylolisthesis was consistent.5.The VAS pain score and ODI score was done in the two groups of patients before and after surgery.The VAS score of the TLIF group before treatment was(7.45 ± 0.71),and PLIF group’s VAS score was(7.47 ± 0.69),there was no significant difference between the two groups before treatment(P > 0.05).After treated by the two surgeries respectively,the VAS score of the TLIF group before treatment was(1.87 ± 0.68),and PLIF group’s VAS score was(2.01 ± 0.70).There was significant difference of the two groups of patients with VAS score before and after the two surgeries respectively and it indicated that two kinds of operation mode can well alleviate the pain of patients.However,there was no significant difference in the VAS score between the two groups after the operation,that indicated the effect of the two methods on improving the pain of the patients were the same.The ODI score of the TLIF group before treatment was(18.51 ± 2.21),and PLIF group’s ODI score was(18.54 ± 2.19),there was no significant difference between the two groups before treatment(P > 0.05).After treated by the two surgeries respectively,the ODI score of the TLIF group before treatment was(3.64 ± 2.17),and PLIF group’s ODI score was(3.68 ± 2.20).There was significant difference of the two groups of patients with ODI score before and after the two surgeries respectively and it indicated that two kinds of operation mode can well improve the lumbar function of patients.However,there was no significant difference in the ODI score between the two groups after the operation,that indicated the effect of the two methods on improving the lumbar spine of the patients were the same.6.There were no postoperative complications in patients of TLIF group after surgery.There was 1 case of patients of PLIF group with nerve root injury and the rest of the patients did not have any complications.There was no significant difference in the incidence of postoperative complications between the two types of operation after statistical analysis.Conclusion The clinical effect of the treatment of TLIF surgery and PLIF surgery in elderly patients with degenerative lumbar spondylolisthesis and lumbar spinal stenosis was fairly equivalent.With less trauma,the TLIF surgery can retain more pedicle bone tissues and can reduce the damage to the dural sac and nerve root in the operation.However,the indication of TLIF is relatively narrow.Therefore,it should be based on the specific circumstances of the patient to develop a more equitable personalized surgery program in the actual clinical work. |
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