椎弓根螺钉内固定联合后外侧植骨融合术治疗对腰椎滑脱症患者围术期指标JOA评分VAS评分及并发症的影响  

Effect of Pedicle Screw Fixation Combined with Posterolateral Bone Grafting and Fusion on Perioperative Indexes,JOA score,VAS score and Complications in Patients with Lumbar Spondylolisthesis

作　　者：韦玮 卢显威 黄林海 兰敏东 黄绍东 WEI wei;LU Xianwei;HUANG Linhai(Guangxi Medical University,Guangxi Nanning 530199,China)

机构地区：[1]广西医科大学附属武鸣医院骨科,广西南宁530199

出　　处：《河北医学》2018年第12期2004-2008,共5页Hebei Medicine

基　　金：广西壮族自治区卫生和计划生育委员会科研课题;(编号:Z20182037)

摘　　要：目的:观察椎弓根螺钉内固定联合后外侧植骨融合(posterolateral lumbar fusion,PLF)术治疗对腰椎滑脱症患者围术期指标、日本矫形外科学会(JOA)评分、视觉模拟疼痛(VAS)评分及并发症的影响。方法:将2013年2月至2016年12月我院收治的60例腰椎滑脱症患者纳入研究,随机分为两组,各30例,A组采取椎弓根螺钉内固定联合PLF术,B组采取椎弓根螺钉内固定联合椎间植骨融合术,比较两组各时间点滑脱率、复位率、复位丢失率以及椎间隙高度丢失率,并观察两组术前与随访结束时JOA评分、VAS评分、治疗效果、手术指标(术中出血量与手术时间)、术后植骨融合率、并发症情况。结果:两组治疗均达有效,比较无明显差异(P>0.05);两组手术时间、术中出血量比较无统计学意义(P>0.05),B组术后植骨融合率明显高于A组(P <0.05);两组术前与随访结束时JOA评分、VAS评分比较无明显差异(P>0.05);两组JOA评分均较术前明显升高(P<0.05),VAS评分均较术前明显降低(P<0.05); A组随访时滑脱率、椎间隙高度丢失率、复位丢失率及并发症总发生率明显高于B组(P <0.05)。结论:椎弓根螺钉内固定联合PLF或者椎间植骨融合术治疗腰椎滑脱症,均能产生良好疗效,相较于PLF,椎弓根螺钉内固定联合椎间植骨融合术可以维持滑脱校正,具有降低术后并发症风险优势。Objective:To observe the effects of pedicle screw fixation combined with posterolateral lumbar fusion(PLF)on perioperative indexes,JOA score,VAS score and complications in patients with lumbar spondylolisthesis.Methods:A total of 90 patients with lumbar spondylolisthesis treated in the hospital from February 2013 to December 2016 were enrolled in the study.They were randomly divided into 2 groups with 30 patients in each group.Group A was treated with pedicle screw fixation combined with PLF,while group B was treated with pedicle screw fixation combined with intervertebral fusion.The spondylolisthesis rate,reduction rate,reduction loss rate and height loss rate were compared between the 2 groups at different time points.The JOA scores,VAS scores,therapeutic effects,operative indicators(intraoperative blood loss and operative time),postoperative bone graft fusion rate and complications in both groups were observed before treatment and at the end of follow-up.Results:The treatment was effective in both groups(P>0.05).There was no statistically significant difference in the operative time or intraoperative blood loss between the 2 groups(P>0.05).The bone graft fusion rate in group B was significantly higher than that in group A(P<0.05),but there was no significant difference in JOA score or VAS score between the two groups before operation and at the end of follow-up(P<0.05).JOA scores of both groups were significantly higher than while VAS scores were significantly lower than those before operation(P<0.05).The spondylolisthesis rate,height loss rate,reduction loss rate and the total incidence of complications in group A were significantly higher than those in group B during follow-up(P<0.05).Conclusion:Pedicle screw fixation combined with PLF or intervertebral fusion is effective in the treatment of lumbar spondylolisthesis.Compared with PLF,pedicle screw internal fixation combined with intervertebral fusion can maintain the correction of spondylolisthesis,with a advantage of reducing the risk of postoperative comp

关 键 词：腰椎滑脱症 椎弓根螺钉内固定 后外侧植骨融合 椎间植骨融合 

分 类 号：R687.3[医药卫生—骨科学]