不同入路椎间融合术治疗腰椎管狭窄症合并腰椎失稳症的效果  

Effect of different approaches of lumbar interbody fusion in the treatment of lumbar spinal stenosis complicated with lumbar instability

作　　者：陆江[1] 阿迪力·热西丁[1] Lu Jiang;Adili·Rexiding(Department of Orthopedics,the First People's Hospital of Aksu Prefecture in Xinjiang,Xinjiang,Akesu 843000,China)

机构地区：[1]新疆阿克苏地区第一人民医院骨二科,新疆阿克苏843000

出　　处：《中国医学前沿杂志（电子版）》2020年第7期97-101,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：新疆维吾尔自治区自然科学基金资助项目(2018x269)。

摘　　要：目的比较不同入路椎间融合术治疗腰椎管狭窄症合并腰椎失稳症的临床效果。方法选择2015年4月至2019年4月新疆阿克苏地区第一人民医院收治的92例腰椎管狭窄症合并腰椎失稳症患者为研究对象,采用随机数字表法将其分别纳入经后方入路椎间融合术(posterior lumbar interbody fusion,PLIF)组和经椎间孔入路椎间融合术(transforaminal lumbar interbody fusion,TLIF)组,每组各46例,分别行微创PLIF、TLIF治疗。比较两组患者手术情况、治疗效果、并发症发生情况、视觉模拟评分法(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评分,分析两种术式的疗效与安全性。结果TLIF组患者手术时间、术后卧床时间均显著短于PLIF组(均P<0.05),术中出血量显著少于PLIF组(P<0.05),术后并发症总发生率显著低于PLIF组(P<0.05),术后3个月治疗优良率显著高于PLIF组(P<0.05)。两组患者均获得有效随访,随访时间为(4.72±0.53)个月。两组患者术后3个月VAS评分和ODI评分均显著低于本组术前(均P<0.05),且TLIF组患者上述评分均显著低于PLIF组(均P<0.05)。结论与PLIF相比,TLIF治疗腰椎管狭窄症合并腰椎失稳症的临床效果更佳,且安全性更高,在缩短患者术后恢复时间、缓解疼痛和提高日常生活能力方面具有显著优势。Objective To compare the clinical effects of two different approaches of lumbar interbody fusion in the treatment of lumbar spinal stenosis complicated with lumbar instability.Method A total of 92 patients with lumbar spinal stenosis complicated with lumbar instability admitted to the First People's Hospital of Aksu Prefecture in Xinjiang from April 2015 to April 2019 were selected as the subjects,they were enrolled into posterior lumbar interbody fusion(PLIF)group and transforaminal lumbar interbody fusion(TLIF)group by random number table method,with 46 patients in each group.The operation,treatment effect,complications,visual analogue scale(VAS)score,Oswestry dysfunction index(ODI)score were compared between the two groups,and the efficacy and safety of the two operation were analyzed.Result The operation time and postoperative bed rest time of patients in TLIF group were significantly shorter than those in PLIF group(all P<0.05),the total blood loss during operation was significantly less than that in PLIF group(P<0.05),the total incidence of postoperative complications was significantly lower than that in PLIF group(P<0.05),and the excellent and good rate of treatment 3 months after operation was significantly higher than that in PLIF group(P<0.05).Patients in both groups were followed up for(4.72±0.53)months.The VAS scores and ODI scores of patients in both groups were significantly lower than those before operation(all P<0.05),and those scores in TLIF group were significantly lower than those in PLIF group(all P<0.05).Conclusion Compared with PLIF,TLIF has better clinical efficacy and higher safety in the treatment of lumbar spinal stenosis complicated with lumbar instability,and has obvious advantages in shortening postoperative recovery time,relieving pain and improving the activity of daily living.

关 键 词：经椎间孔入路 椎间融合术 腰椎管狭窄症 腰椎失稳症 

分 类 号：R687.3[医药卫生—骨科学]