融合术与弹性棒非融合术治疗腰4/5椎间盘突出的中长期疗效及临近节段退变的比较  

A comparative study of the mid-and long-term outcome and adjacent segment degeneration of lumbar disc herniation treated by fusion and non-fusion with elastic rod

作　　者：黄世磊[1] 皮国富[1] 刘宏建[1] 孙建广[1] 宋瑞鹏[1] 谢政 陈扬扬 Huang Shilei;Pi Guofu;Liu Hongjian;Sun Jianguang;Song Ruipeng;Xie Zheng;Chen Yangyang(Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院骨科,450000

出　　处：《中华实验外科杂志》2021年第11期2266-2268,共3页Chinese Journal of Experimental Surgery

摘　　要：目的对比弹性棒非融合术及融合术治疗单节段腰4/5椎间盘突出(LDH)的临床疗效、椎间隙高度及腰椎-骨盆矢状位参数等数据的变化,评估弹性棒系统在临床中长期应用的价值。方法郑州大学第一附属医院收治57例单节段腰4/5 LDH患者,分为融合组31例,非融合组26例,比较分析两组患者一般资料及手术前后Oswestry功能障碍指数(ODI)、疼痛视觉模拟量表(VAS)评分和日本矫形外科学会评分(JOA)和腰3/4、4/5、腰5/骶1节段椎间隙前缘及后缘高度、PI、PT、SS、LL等资料,组间比较采用两独立样本的t检验,组内比较采用配对t检验。结果两组ODI、JOA及VAS评分术前、术后3年及末次随访差异均无统计学意义(P>0.05),两组患者术后临床效果均满意;B组腰4/5间隙前缘及后缘术后末次随访高度小于A组[(12.13±1.65) mm比(13.72±2.38) mm,t=2.889,P<0.05;(7.03±1.19) mm比(8.03±1.69) mm,t=2.556,P<0.05];B组LL值末次随访小于A组[(41.50±4.72)°比(44.66±6.54)°,t=2.049,P<0.05]。B组SS值术前、术后3年随访及术后末次随访均大于A组[(35.02±4.42)°比(31.59±5.38)°,t=2.595,P<0.05;(34.92±4.59)°比(0.43±5.11)°,t=3.501,P<0.05;(29.91±4.20)°比(32.37±4.59)°,t=2.108,P<0.05]。结论两种术式治疗单节段腰4/5 LDH都能取得良好的长期临床效果,非融合术的手术时间较短,术中出血量较少;融合术能较好的维持责任节段椎间隙前缘高度;非融合术能更好的维持临近节段腰3/4后缘、腰5/骶1前缘椎间隙高度及SS值。Objective To compare the clinical efficacy,operative level,intervertebral height and sagittal parameters of Lumbar spine-pelvis in the treatment of single-level Lumbar 4/5 LDH with elastic Rod non-fusion technique and fusion technique,to evaluate the value of elastic rod system in clinical application.Methods The data of 57 young and middle-aged patients with single level Lumbar 4/5 LDH,31 patients in the fusion group(Group A)and 26 patients in the non-fusion Group(Group B)were analyzed,preoperative Lumbar 3/4,4/5,Lumbar 5/Sacral 1 segment anterior and posterior edge height,PI,PT,SS,LL and so on.T test of two independent samples was used in the comparison between groups,paired t test was used in the comparison within groups.Results There was no significant difference in oswestry disability index(ODI),visual analogue scale(VAS)and Japanese Orthopedic Association(JOA)scores before operation,3 years after operation and the last follow-up between the two groups(P>0.05).The clinical effect of the two groups was satisfactory;The last follow-up height of the anterior and posterior Lumbar 4/5 space in Group B was lower than that in Group A[(12.13±1.65)mm vs.(13.72±2.38)mm,t=2.889,P<0.05;(7.03±1.19)mm vs.(8.03±1.69)mm,t=2.556,P<0.05];(3)The value of LL in Group B was lower than that in Group A[(41.50±4.72)°vs.(44.66±6.54)°,t=2.049,P<0.05].The value of SS in Group B was more than that in Group A[(35.02±4.42)°vs.(31.59±5.38)°,t=2.595,P<0.05;(34.92±4.59)°vs.(30.43±5.11)°,t=3.501,P<0.05;(29.91±4.20)°vs.(32.37±4.59)°,t=2.108,P<0.05].Conclusion Two kinds of Lumbar 4/5 LDH treatment can achieve good long-term clinical results,non-fusion surgery time is shorter,less intraoperative bleeding.Fusion can better maintain the level of responsibility segment of the anterior edge of intervertebral space.Non-fusion can better maintain the Lumbar 3/4 posterior edge,Lumbar 5/Sacral 1 anterior edge intervertebral space height and SS value of adjacent segment.

关 键 词：腰椎间盘突出症 弹性棒 单节段 矢状位参数 

分 类 号：R687.3[医药卫生—骨科学]