经椎间孔椎间融合术联合椎弓根钉固定在腰椎退行性疾病中的疗效及预后分析  

The Efficacy and Long-Term Prognosis Analysis of Transforaminal Lumbar Interbody Fusion Combined with Pedicle Screw Fixation in Lumbar Degenerative Diseases

作　　者：孔祥瑞[1] 杨计策 孔祥云[1] 刘海峰[1] 郭元凯[1] 张佳丽[1] 陈贺[1] 张福明[1] 

机构地区：[1]涿州市医院骨一科,河北涿州072750

出　　处：《医学综述》2015年第21期3998-4001,共4页Medical Recapitulate

摘　　要：目的分析经椎间孔椎间融合术(TLIF)联合椎弓根螺钉固定在腰椎退行性疾病中的疗效及远期预后。方法选取2010年5月至2014年5月涿州市医院收治的96例腰椎退行性疾病患者为研究对象,按照随机数字表法分为观察组和对照组,各48例。观察组实施TLIF联合椎弓根螺钉固定术,对照组实施传统的经后路腰椎间融合手术。术后均给予抗生素静脉滴注治疗,并对患者进行为期5年的随访和X线平片复查,观察两组患者的疼痛、并发症、植骨融合情况,进行Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS),对两种手术的疗效进行对比分析。结果观察组患者的住院时间、术中失血量、切口长度、术后引流量均明显少于对照组[(9.9±1.1)d比(12.2±0.9)d;(302±30)m L比(338±44)m L;(2.6±0.7)cm比(6.3±2.5)cm;(87±13)m L比(119±20)m L],但观察组的手术时间长于对照组[(134±20)min比(109±26)min],差异有统计学意义(P<0.01);按照改良Mac Nab标准的疗效评定结果显示,两组患者临床疗效比较差异无统计学意义(P>0.05);两组患者的植骨融合率均较高,融合情况好,但两组比较差异无统计学意义(P>0.05);两组患者的ODI评分、VAS较术前均明显改善,差异有统计学意义(P<0.05);观察组总并发症发生率低于对照组[48.9%(22/45)比64.3%(27/42)],差异有统计学意义(P<0.05)。结论 TLIF联合椎弓根螺钉固定在腰椎退行性疾病中疗效显著,远期预后效果良好。较传统的手术方法具有创伤小、失血量少、并发症少的优点,是值得推广应用的治疗腰椎退行性疾病的安全有效的方法。Objective To-analyze the efficacy and long-term prognosis of transforaminal lumbar inter-body fusion（TLIF） joint pedicle screw FLxation in lumbar degenerative diseases. Methods A total of 96 patients with degenerative lumbar disease were chosen from Zhuozhou City Hospital from May 2010 to May 2014 in this study,according to random number table method they were divided into obervation group and control group,48 cases each. TLIF joint pedicle screw fixation was implemented for the observation group, while the traditional posterior lumbar fusion surgery was implemented for the control group. Postoperative anti- hiotics were given by intravenous administration, and 5-year fallow-up and X-ray review to observe pain, com- plications, hone fusion, and conduct oswestry disability index （ODI）, pain visual analogue scale （VAS） sco- ring to compare the efficacy of the two procedures. Results The hospitalization days, intraoporative blood loss,lncislon length, postoperative drainage were significantly less than the control group [ （ 9. 9 ± 1.1 ） d vs （12.2±0.9） d;（302 ±30） mLvs （338±44） mL;（2.6±0.7） emvs （6.3±2.5） cm;（87 ±13） mL vs （ 119 ± 20） niL ], hut the surgery time of the observation group was longer [ （ 134 ± 20 ） rain vs （ 109 ± 26） mini ,the difference was statistically significant（ P 〈0. 01 ） ;there was no significant difference in the clinical efficacy according to the modified MacNab criteria（ P 〈 0. 05 ） ; both groups had high fusion rate with good fusion status, the difference between groups was not statistically significant （P 〉 0. 05 ）. After 5 years of observation, ODI, VAS scores of both groups were significantly improved compared than before operation with significant dii±[erences（ P 〈 0. 05 ） ; and complication rate in the observation group was lower than the control group E 48.9 % （22/45） vs 64. 3 % （ 27/42 ） ] （ P 〈 0. 05 ）. Conclusion TLIF combined with pedicle screw fixation has significant effect for

关 键 词：腰椎退行性疾病 经椎间孔椎间融合术 椎弓根螺钉 疗效 远期预后 

分 类 号：R684[医药卫生—骨科学]