Analysis The Outcome Of Diferent Fusion Techniques For Lumbar Spondylolisthesis

ObjectivesAnalysis and comparison the therapeutic effectiveness of spondylolisthesis treated with different fusions,find the advantages and disadvantages for clinical application and provide a theoretical basis.Methods77 cases in service were divided into three groups,namely A group treated with pedicle screw and intertransverse bone-graft fusion;B group treated with pedicle screw,posterior lumbar interbody fusion and "H" type bone grafting; C group treated with pedicle screw and posterior lumbar interbody fusion.In Group A of 20 cases,12 cases with degenerative spondylolisthesis were aged from 39 to 71 years old with an average of 56.0 years old;8 cases with spondylolysis detachment were aged from 32 to 67 years old with an average of 52 years old.In Group B of 31 cases,21 cases with degenerative spondylolisthesis were aged from 35 to 69 years old with an average of 55.8 years; 10 cases with spondylolysis detachment were aged from 30 to 65 years old with an average of 49.5 years old.In Group C of 26 cases,15 cases with degenerative spondylolisthesis were aged from 38 to 65 years old with an average of 53.5 years old;11 cases with spondylolysis detachment were aged from 31 to 64 years old with an average of 50.3 years old.The three groups have no significant differences among age,gender,type and degree of spondylolisthesis.All the groups wre treated with Buyanghuanwu decoction after lumbar surgery.Use low back pain assessment standards of Japan Orthopedic Association(JOA),VAS pain score,SUK S fusion standards,Taillard index,Boxall index,interverteb-Ral space height index,lumbosacral joint angles and other indicators for observation, apply spss13.0 for windows statistical software to trip t-test,X~2 test or analysis of variance testing selectively,and so the results were statistically analyzed in order to observe and evaluate the therapeutic effecttiveness of spondylolisthesis treated with different fusions.ResultThere were 77 cases followed up for 1 to 2 years.The average operative time was 180min and the average blood loss was 550ml in Group A;the average operative time was 250min and the average blood loss was 905ml in Group B; the average operative time was 220min and average blood loss was 850ml in Group C.Group A in the average operative time and blood loss is better than Group B and C,there is no significant difference between B and C groups.Among the three different fusions,there are markedly improvements in lumbar spondylolisthesis' diaplasis after operation.There are no significant difference among A,B and C groups in lumbar spondylolisthesis' diaplasis after operation.The vertebral height restoration of Group B and C is superior to Group A,Group A' s intervertebral space height can not be restored,and even some height lost.Group B and C' s fusion rates are higher than the rate of Group A,Group B' s fusion rate is optimal.The clinical efficacy is markedly improved among Group A,B and C after operation,but B and C groups improve more obvious.Group B and C have less combination complications than Group A and Group B has less secondary spinal stenosis than Group A and C.ConclusionIntertransverse bone-graft fusion,posterior lumbar interbody fusion and "H" type bone grafting are effective fusion method.Intertransverse bone-graft fusion has shortest operative time,least blood loss than posterior lumbar interbody fusion and "H" type bone grafting.But the fusion rate is low and it can not restored intervertebral space height.The therapeutic effectiveness is worst and it has more surgery complications.Posterior lumbar interbody fusion,which cage is an effective support fusion method,is best suited to the physical demands.It has high rate of fusion and good curative effect after operation.It can resume intervertebral space height.But the surgical trauma is great and its blood loss is large."H" type bone grafting can cover defects after laminectomy and avoid scar tissue of postoperation into the spinal canal,which will not only ease the nerve root' s pain but also eliminate a hidden dangerous fact as nerve root' s oppression.The large number of cancellous bone graft can promote integration and maintain good spinal stability.So "H" type bone grafting is a better way of fusion.