2种术式对单节段退变性腰椎管狭窄症患者骨性结构参数改变的影响  

Effects of Two Different Surgical Methods on Changes of Bone Structure Parameters in Patients with Single-segment Degenerative Lumbar Spinal Stenosis

作　　者：孙博 崔红旺 SUN Bo;CUI Hong-wang(Department of Spine and Bone Disease,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院脊柱骨病外科,海口570102

出　　处：《解放军医药杂志》2021年第9期40-44,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：2017年度国家级地区科学基金项目(81760260)。

摘　　要：目的探究单节段退变性腰椎管狭窄症患者采用Quadrant通道下微创椎间孔椎间融合术和改良后路减压椎间植骨融合术治疗对患者骨性结构参数的影响。方法选取我院2018年6月—2019年6月收治的单节段退变性腰椎管狭窄症103例,将行Quadrant通道下微创椎间孔椎间融合术(misTLIF)、改良后路减压椎间植骨融合术患者分别纳入misTLIF组(60例)和对照组(43例)。比较2组围术期指标,手术疗效,手术前后疼痛视觉模拟评分法(VAS)评分、Oswerstry功能障碍指数评分及日本骨科协会评估(JOA)评分,手术前后骨性结构参数,术后植骨融合率及手术并发症。结果misTLIF组术中失血量少于对照组,手术时间长于对照组,术后下床时间、住院时间短于对照组,住院费用低于对照组,差异有统计学意义(P<0.01)。misTLIF组手术优良率高于对照组(P<0.05)。2组术后VAS评分、Oswerstry功能障碍指数评分及JOA评分均较术前显著改善(P<0.05);术后misTLIF组VAS评分、Oswerstry功能障碍指数评分低于对照组,JOA评分高于对照组,差异有统计学意义(P<0.05)。与术前比较,2组术后腰椎前凸角、腰骶角显著增大(P<0.05);术后misTLIF组腰椎前凸角、腰骶角大于对照组(P<0.05)。misTLIF组植骨融合率高于对照组(P<0.05),2组手术并发症总发生率比较差异无统计学意义(P>0.05)。结论单节段退变性腰椎管狭窄症患者采用Quadrant通道下misTLIF术治疗具有微创、恢复迅速的优势,并可促进患者腰椎功能恢复,减轻患者疼痛,有效改善病变所致骨性结构参数,手术效果良好。Objective To investigate the effect of minimal invasive transforaminal lumbar interbody fusion(misTLIF)under the Quadrant channel and modified posterior decompression and fusion on bone structure parameters of patients with single-segment degenerative lumbar spinal stenosis.Methods A total of 103 patients with single-segment degenerative lumbar spinal stenosis admitted between June 2018 and June 2019 were selected,and patients undergoing misTLIF under the Quardrant channel were included in misTLIF group(n=60),while patients undergoing modified posterior decompression and fusion,were included in control group(n=43).Values of perioperative indexes,surgical efficacy,pain visual analogue scales(VAS)score before and after operation,Oswerstry dysfunction index score and the Japanese Orthopaedic Association(JOA)score,parameters of bone structure before and after operation,fusion rate of postoperative bone graft and incidence rate of complications were compared between two groups.Results Compared with those in control group,intraoperative volume of blood loss was less,operative duration was longer,the time of first postoperative off-bed activity and length of hospitalization were shorter,and the hospitalization cost was less in misTLIF group(P<0.01).The good and excellent rate of operation in misTLIF group was significantly higher than that in control group(P<0.05).Scores of VAS,Oswerstry index and JOA were significantly improved after operation compared with those before operation in two groups(P<0.05).After treatment in misTLIF group,scores of VAS and Oswerstry index were significantly lower than those in control group,while JOA score was significantly higher than that in control group(P<0.05).Compared with those before operation,values of lumbar lordosis angle(LLA)and lumbosacral angle(LSA)were significantly increased after operation in two groups(P<0.05);values of postoperative LLA and LSA in misTLIF group were significantly greater than those in control group(P<0.05).The fusion rate of the graft in misTLIF group was

关 键 词：椎管狭窄 腰椎 脊柱融合术 骨性结构参数 前凸角 腰骶角 手术后并发症 

分 类 号：R681.5[医药卫生—骨科学]