中文摘要：

目的对比小切口与传统开放术式单节段后路腰椎椎体间融合（posteriorlumbarinter-bodyfusion，PLIF）术后邻近节段退变的差异。方法2005年10月至2008年9月，应用PLIF手术治疗下腰椎病变的患者108例。小切口组56例，男33例，女23例；年龄32～68岁，平均53．8岁。开放组52例，男24例，女28例；年龄27-69岁，平均52．6岁。随访时间小切口组46-55个月，平均48．6个月；开放组47-60个月，平均50．2个月，两组随访率分别为91．1％（51／56）和88．5％（46／52）。比较两组术后疼痛视觉模拟评分（visualanalogscale，VAS）、Oswestry功能障碍指数（Oswestrydisabilityindex，ODI）、多裂肌损伤和邻近节段退变。结果VAS评分和ODI术前两组间的差异无统计学意义，术后小切口组均明显低于开放组。小切口组术后多裂肌横截面积减小和脂肪化程度明显低于开放组。小切口组术后出现邻近节段影像学退变的4例中2例出现腰腿痛症状；开放组术后出现邻近节段影像学退变11例中4例发生症状学退变，其中2例须再手术。邻近节段影像学和症状学退变均与术后多裂肌横截面积减小、脂肪沉积相关，但只有症状学退变与临床疗效（VAS评分和ODI）相关。结论与传统PLIF手术相比，小切口PLIF手术具有临床疗效好、多裂肌萎缩发生率低、影像学邻近节段退变发生率低等优点。

英文摘要：

Objective To compare the difference of adjacent segment degeneration （ASD） following one-level mini-open or conventional open posterior lumbar interbody fusion （PLIF）. Methods From October 2005 to September 2008, 108 patients underwent one-level instrumented PLIF using two different approach- es： mini-open approach in 56 patients including 32 males and 23 females, aged from 32 to 68 years （aver- age, 53.8 years） and conventional open approach in 52 patients including 24 males and 28 females, aged from 27 to 69 years （average, 52.6 years）. The follow-up rates of the mini-open and conventional open groups were 91.1% and 88.5%, respectively. The visual analog scale （VAS）, Oswestry disability index （ODI）, multi- fidus muscle injury and ASD were evaluated. Results There were no significant differences in VAS and O- DI scores between two groups preoperatively, but the two scores in the mini-open group were significantly lower than those in conventional open group after surgery. Compared with the conventional open approach, less decrease of cross sectional area and less severe fatty degeneration of the multifidns muscle were ob- served in mini-open group. There were 4 cases of radiographic ASD in the mini-open group including two symptomatic cases, and 11 cases in the conventional open group including 4 symptomatic cases among them 2 required surgical intervention. Both radiographic and symptomatic ASD were correlated with the decrease of cross sectional area and degree of fatty degeneration of the mnltifidus muscle, but only symptomatic ASD was associated with the clinical results. Conclusion Compared with the conventional open approach, the mini-open PLIF has many advantages, such as better clinical outcomes, lower incidence of multifidus muscle atrophy, and lower incidence of radiographic ASD.