保留邻椎后方韧带复合体的改良后路椎间融合术临床疗效观察  

Clinical outcomes of improved PLIF with the adjacent vertebral posterior ligamentous complex

作　　者：郭时空 高浩然[1] 钱澍[1] 李存孝[1] 钱济先[1] 

机构地区：[1]第四军医大学唐都医院骨科,陕西西安710038

出　　处：《中国矫形外科杂志》2014年第11期990-995,共6页Orthopedic Journal of China

摘　　要：[目的]比较改良PLIF手术和传统PLIF手术患者术后邻近节段退变发生的差异，探讨后方韧带复合体对预防邻近节段退变发生的意义。[方法]选取本科2010年3月一2012年10月间分别行传统PLIF手术和改良PLIF手术的患者（传统组78例，改良组80例），随访12—36个月，平均28个月，选取X线评价两组患者术后邻近节段退变的差异，临床疗效采用疼痛视觉模拟评分（VAS）和Oswestry功能指数（ODI）进行评估。[结果]两组患者在性别、年龄、手术节段等一般资料间比较，差异无统计学意义（P〉0．05）。术后末次随访时两组患者的VAS评分和ODI功能指数较术前均明显下降，差异有统计学意义（P〈0．05），但两组间的比较无统计学意义（P〉0．05）。末次随访时，改良组9例出现影像学退变（退变率为11．3％）、3例症状学退变（退变率为3．8％），传统组32例出现影像学退变（退变率为41．0％）、11例症状学退变（退变率为14．1％），两组间差异均有统计学意义。影像学退变与临床疗效间无明显相关性（P〉0．05），只有症状学退变与临床疗效相关（P〈0．05）。[结论]保留邻椎后方韧带复合体的改良PLIF手术与传统PLIF手术相比，术后邻近节段退变率明显降低，后方韧带复合体在防止邻近节段退变发生中起到重要作用。[ Objective] The present study aimed to compare adjacent segment degeneration （ASD） after improved posteri- or lumbar interbody fusion （PLIF） with the adjacent vertebral posterior ligamentous complex versus that after traditional PLIF and explore the significance of the posterior ligamentous complex in preventing ASD. [ netbodsl Between March 2010 and Oc- tober 2012, 178 patients underwent traditional or improved PLIF （78 and 80 cases, respectively） and were followed up for 12 ~ 36 months （ mean, 28 months） . ASD was evaluated radiographically, while the clinical effects were evaluated using visual ana- logue scale （VAS） and Oswestry disability index （ODI） scores. [ Results] No significant differences in age, gender, clinical diagnosis, or segment were observed between the 2 groups （ P 〉 0. 05 ） . The VAS and ODI scores at the time of the last follow - up were significantly lower than the preoperative scores （ P 〈 0. 05 ） , but no significant difference in scores was noted between the 2 groups （P 〉0. 05 ） . At the last follow - up, there were 9 cases （ degeneration rate, 11.3 % ） of radiographic ASD in the improved group including 3 symptomatic cases （ degeneration rate, 3.8% ） as well as 32 cases （ degeneration rate, 41.0% ） in the traditional group including 11 symptomatic cases （degeneration rate, 14. 1% ） （P 〈 0. 05 ） . There were no obvious correla- tions between radiographic ASD and the clinical effect （ P 〉 0. 05 ）, whereas symptomatic ASD was significantly associated with the clinical results （ P 〈 0. 05 ） . [ Conclusion ] Compared with traditional PLIF, improved PLIF has a lower incidence of ASD, which suggests that the posterior ligamentous complex has the important function of preventing ASD.

关 键 词：腰椎 椎间融合术 邻近节段退变 后方韧带复合体 

分 类 号：R687.3[医药卫生—骨科学]