保留后方韧带复合体椎间融合术与PLIF术式治疗腰椎间盘突出症的临床比较分析  

Clinical comparative analysis of posterior ligament complex interbody fusion and PLIF operation in the treatment of lumbar disc herniation

作　　者：魏波[1] 范杰[1] 张禄[1] 吴德民[1] 姜正明[1] 

机构地区：[1]兖矿集团总医院脊柱外科,山东邹城273500

出　　处：《颈腰痛杂志》2017年第3期265-268,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨腰椎间盘突出症患者行后路椎间融合术(Posterior Lumbar Interbody Fusion,PLIF)时,保留后方韧带复合体对手术疗效的影响。方法随机选择2012-09-2015-03收治的120例腰椎间盘突出症患者,分为观察组和对照组各60例,其中对照组给予传统的PLIF术式,观察组予以保留后方韧带复合体的PLIF手术(术中对棘突、棘上和棘间韧带予以保留),对比两组的疗效。结果两组患者均顺利完成手术,未出现脑脊液漏、感染、血肿形成等早期并发症,所有切口均一期愈合。观察组的手术时间明显少于对照组,且术中出血量也明显低于对照组,差异均有统计学意义(P<0.05)。术后各时间点VAS评分比较,两组无显著差异(P>0.05),但观察组术后1个月和半年时,ODI指数较对照组改善更为明显(P<0.05),术后1年时则较为接近(P>0.05)。两组患者均随访1-2年,平均17个月。观察组仅1例未椎间融合,对照组仅2例,两组融合情况比较无显著差异(P>0.05)。结论与传统的PLIF术式相比,保留后方韧带复合体的PLIF手术时间短、术中出血少,且术后半年内功能恢复更佳,有一定的临床优势。Objective To investigate the effect of posterior ligament complex on the surgical outcome of posterior lumbar interbody fusion （PLIF） in patients with lumbar disc herniation. Methods 120 cases of lumbar disc herniation were randomly selected from September 2012 to March 2015. They were divided into observation group and control group, 60 cases in each group. The control group was treated with traditional PLIF surgery. The observation group retained posterior ligamentous complex surgery （PLIF surgery on the spine, supraspinal and interspinal ligaments to be retained）. The efficacy of two groups was compared. Results Two groups of patients were successfully completed surgery, no early complications such as cerebrospinal fluid leakage, infection, hematoma formation, all incisions were healed. The operation time of the observation group was significantly less than that of the control group, and the amount of bleeding during operation was significantly lower than that of the control group, the difference was statistically significant （P〈0.05）. At each time point after surgery, VAS score had no significant difference between the two groups （P〉0.05）, but 1 month and half a year after operation, the ODI index of the observation group improved more obviously than the control group （P〈0.05）, 1 year after operation, it was similar in two groups（P〉0.05）. All the two groups were followed up for 1-2 years, average 17 months. In the observation group, there was only 1 case without interbody fusion. There were only 2 cases in the control group, and there was no significant difference between the two groups （P〉0.05）. Conclusion Compared with the traditional PLIF, the operation time of the posterior ligament complex is shorter than PLIF, and less bleeding during the operation. The recovery is better in the second half year.

关 键 词：腰椎间盘突出症 后方韧带复合体 腰椎后路椎间融合术 

分 类 号：R681.53[医药卫生—骨科学]