单侧入路双侧减压TLIF手术与双侧小切口PLIF手术治疗腰椎管狭窄症的疗效对比  

Treatment of lumbar spinal stenosis by unilateral TLIF bilateral decompression and bilateral small incision PLIF

作　　者：陈宏亮 云才 李士春 肖士鹏 李钦亮 CHEN Hong-liang;YUN Cai;LI Shi-chun(Department of Orthopadics, Shijingshan Hospital of Beijing, 100043. China)

机构地区：[1]首都医科大学石景山教学医院北京市石景山医院骨科,北京100043

出　　处：《颈腰痛杂志》2019年第2期149-152,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨后路减压椎间植骨融合内固定手术治疗腰椎管狭窄症的手术疗效,并对比单侧入路双侧减压TLIF手术与双侧小切口PLIF手术的临床疗效。方法共纳入2013-07-2015-07手术治疗的71例腰椎管狭窄症患者,依据随机数字表法,将71例分为两组:其中A组33例,均采用单侧入路双侧减压TLIF手术治疗;B组38例,均采用双侧小切口PLIF手术治疗。术后均随访2年以上,对比两组患者的手术疗效。结果两组手术时间、术中出血量和住院时间均相近,但与B组相比,A组的术后引流量更少(P<0.05),且A组术后1、3 d的肌酸磷酸激酶(CPK)水平显著低于B组(P<0.05);两组术后VAS评分和ODI评分均显著低于术前,但A组术后3、12个月的两项指标均显著低于B组(P<0.05);末次随访时,A组的椎间融合率为93.9%(31/33),B组为92.1%(35/38),组间差异无统计学意义(P>0.05)。结论与双侧小切口PLIF手术相比,单侧入路双侧减压技术行TLIF手术治疗腰椎管狭窄症亦可取得较好疗效,且创伤更小,较好地保留了脊柱后方结构,有临床应用价值。Objective To investigate the surgical effect of posterior decompression, interbody fusion and internal fixation for lumbar spinal stenosis, and compare the clinical effect of unilateral bilateral decompression with TLIF and bilateral small incision PLIF operation. Methods 71 patients with lumbar spinal stenosis were included in July 2013 -2015 July. According to the random digital table method, 71 cases were divided into two groups:33 cases in group A were treated with unilateral decompression and TLIF operation, and 38 cases in group B were treated with bilateral small incision PLIF operation. All the patients were followed up for more than 2 years, and the curative effect of the two groups was compared. Results the operation time, two groups of blood loss and hospitalization time were similar, but compared with the B group, group A, postoperative drainage less (P<0.05), and group A after 1 and 3 days of creatine phosphate kinase (CPK) levels were significantly lower than those in group B (P<0.05);The VAS score and the ODI score of the two groups were significantly lower than those before the operation, but the two indexes of the 3 and 12 months after operation in group A were significantly lower than those in the group B (P<0.05). At the last follow-up, the rate of interbody fusion in group A was 93.9%(31/33), and in group B was 92.1%(35/38). There was no significant difference between groups (P>0.05). Conclusion compared with bilateral small incision PLIF operation, unilateral unilateral decompression and bilateral TLIF decompression for lumbar spinal stenosis can also achieve better results, with less trauma and better preservation of the posterior structure of the spine, which is of clinical value.

关 键 词：腰椎管狭窄症 对侧潜行减压 经椎间孔椎体间融合术 后路椎体间融合术 

分 类 号：R681.55[医药卫生—骨科学] R687.32[医药卫生—外科学]