三种腰椎固定融合术式治疗腰椎术后邻椎病的疗效对比分析  

Comparative analysis of the clinical efficacies of three surgical methods for the treatment of adjacent segment disease after lumbar fusion

作　　者：马宗军[1] 刘晓印 张建群[1] 吴鹏[1] 陈振[1] 梁思敏[1] 马荣[1] 丁小力[1] 戈朝晖[1] MA Zongjun;LIU Xiaoyin;ZHANG Jianqun(Department of Orthopaedics,General hospital of NingXia Medical University,Yinchuan,750004,China)

机构地区：[1]宁夏医科大学总医院骨科,银川市750001

出　　处：《中国脊柱脊髓杂志》2022年第12期1102-1111,共10页Chinese Journal of Spine and Spinal Cord

基　　金：宁夏自然科学基金资助项目(2020AAC03396);宁夏重点研发计划项目(2020BEG03034)。

摘　　要：目的:分析斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)、后路皮质骨轨迹(cortical bone trajectory,CBT)螺钉固定中线腰椎椎间融合术(midline lumbar interbody fusion,MIDLIF)、传统后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗腰椎融合术后邻椎病的临床疗效。方法:回顾性分析2013年5月~2020年9月收治的60例腰椎融合术后邻椎病患者的临床资料,男31例,女29例;年龄40~73岁(57.4±13.8岁),距首次融合固定术6~84个月(56.3±20.8个月)。融合邻近节段腰椎间盘突出26例,腰椎管狭窄23例,腰椎滑脱不稳11例。依据不同术式分为OLIF组16例、MIDLIF组20例和PLIF组24例。记录3组患者手术时间、术中出血量、住院时间及围手术期情况。应用视觉模拟量表(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评定术前、术后3个月和末次随访时的腰腿痛和腰椎功能情况,在术前、术后3个月的腰椎正侧位X线片上测量邻椎病手术节段椎间隙高度(interbody disc height,IDH)、椎间孔高度(interbody foraminal height,IFH)及椎间孔面积(interbody foraminal area,IFA)。结果:3组患者年龄、性别、病变节段、术前VAS评分和ODI均无统计学差异(P>0.05)。OLIF组术中出血量、手术时间、住院时间分别为125.6±14.5ml、92.3±13.5min、6.3±1.2d,MIDLIF组分别为220.4±15.2ml、120.6±11.4min、10.5±1.4d,PLIF组分别为218.4±12.5ml、115.4±10.7min、10.4±1.4d,OLIF组术中出血量、手术时间、住院时间均较MIDLIF组和PLIF组显著性减少(P<0.05),而MIDLIF组和PLIF组无显著性差异(P>0.05)。随访10~32个月(20.5±5.8个月),OLIF组术后3个月时腰痛、下肢痛VAS评分、ODI分别为2.43±0.52分、2.37±0.63分、(20.47±3.10)%,末次随访时分别为2.10±0.52分、2.05±0.31分、(14.14±2.41)%;MIDLIF组术后3个月时分别为2.84±0.67分、1.93±0.36分、(21.89±3.07)%,末次随访时分别为1.94±0.55分、1.75±0.20分、(1Objectives:To analyze the clinical effects of oblique lumbar interbody fusion(OLIF),posterior cortical bone trajectory(CBT)screw fixation and midline lumbar interbody fusion(MIDLIF)and traditional posterior lumbar interbody fusion(PLIF)in the treatment of adjacent segment diseases(ASD)after lumbar fusion.Methods:The clinical data of 60 patients with adjacent segment diseases after lumbar fusion treated in our hospital between May 2013 and September 2020 were analyzed retrospectively,including 31 males and 29 females,aged 40-73 years(57.4±13.8 years)old.The interval from the first fusion fixation for all the patients was 6-84 months(56.3±20.8 months).Among them,26 cases were with adjacent segment lumbar disc herniation,23 with lumbar spinal canal stenosis,and 11 with lumbar spondylolisthesis and unstable.According to different surgical methods,the patients were divided into OLIF group(n=16),MDLIF group(n=20),and PLIF group(n=24).The operation time,intraoperative blood loss,hospital stay,and perioperative conditions of the three groups of patients were recorded.The visual analogue scale(VAS)and the Oswestry disability index(ODI)were used to evaluate low back and leg pain and lumbar function at preoperation,3 months after surgery,and final follow-up.The interbody disc height(IDH),interbody foraminal height(IFH),and interbody foraminal area(IFA)were measured on anteroposterior lateral X-ray of the lumbar spine at preoperation and 3 months after surgery.Results:There were no statistically significant differences in age,gender,lesion segment,preoperative VAS score and ODI among the three groups of patients(P>0.05).The intraoperative blood loss,operation time,and hospital stay were 125.6±14.5ml,92.3±13.5min,and 6.3±1.2d in OLIF group,220.4±15.2ml,120.6±11.4min,and 10.5±1.4d in MIDLIF group,and 218.4±12.5ml,115.4±10.7min,and 10.4±1.4d in PLIF group.The intraoperative blood loss,operation time,and hospital stay of OLIF group were significantly lower than those in MIDLIF group and PLIF group(P<0.05),while there

关 键 词：邻椎病 脊柱融合 手术方式 临床疗效 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]