侧方入路腰椎椎间融合手术前后黄韧带厚度及面积的变化  

Changes of thickness and area of ligamenta flavum after lateral lumbar interbody fusion

作　　者：边汉明 万文涛 陈超[1] 孙逊 赵栋[1] 杨海云[1] 官丙刚[1] 杨强[1] Bian Hanming;Wan Wentao;Chen Chao;Sun Xun;Zhao Dong;Yang Haiyun;Guan Binggang;Yang Qiang(Department of Spinal Surgery,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院脊柱外科,天津300211

出　　处：《中华骨科杂志》2023年第8期500-507,共8页Chinese Journal of Orthopaedics

基　　金：国家骨科与运动康复临床医学研究中心"以临床应用为导向的医疗创新基金"转化项目(2021-NCRC-CXJJ-ZH-22);天津市杰出青年科学基金项目(18JCJQJC47900)。

摘　　要：目的探讨腰椎退行性疾病患者接受侧方入路腰椎椎间融合(lateral lumbar interbody fusion, LLIF)手术前后黄韧带厚度及面积的变化。方法回顾性分析2019年至2021年因腰椎退行性疾病接受LLIF联合经皮椎弓根螺钉内固定手术治疗的患者54例, 男9例、女45例, 年龄(59.46±6.91)岁(范围45~76岁)。对患者手术前后以及末次随访时椎间隙高度(disc height, DH)、矢状面椎管直径(canal diameter, CD)、硬膜囊轴向横截面积(dural sac axial cross-sectional area, DCSA)、黄韧带面积(ligamentum flavum area, LFA)以及黄韧带厚度(ligamentum flavum thickness, LFT)进行比较。采用Pearson相关性分析评估患者术后即刻及末次随访时DCSA变化量及LFA变化量之间的关系以及二者与DH变化量之间的相关性。提取末次随访为术后12个月的患者资料, 采用Pearson相关性评估末次随访时DCSA变化量及LFA变化量与术后1年视觉模拟评分(visual analogue scale, VAS)以及Oswestry功能障碍指数(Oswestry disability index, ODI)变化量之间的相关性。结果所有患者均获得随访, 随访时间为(14.69±6.87)个月(范围12~33个月)。患者手术前后及末次随访的DH(F=354.93, P<0.001)、矢状面CD(F=44.78, P<0.001)、DCSA(F=130.97, P<0.001)的差异均有统计学意义。术后即刻及末次随访时DH、矢状面CD、DCSA均大于术前, 差异有统计学意义(P<0.05)。手术前后及末次随访的LFA(F=51.59,P<0.001)、双侧LFT(F=53.49, P<0.001;F=50.53, P<0.001)的差异均有统计学意义, 术后即刻和末次随访时的LFA及双侧LFT均小于术前(P<0.05)。Pearson相关性分析显示术后即刻DH变化量与DCSA变化量呈中等相关(r=0.57, P<0.001), 与LFA变化量呈强相关(r=0.65, P<0.001);末次随访时DH变化量与DCSA变化量呈中等相关(r=0.43, P<0.001), 与LFA变化量呈弱相关(r=0.25, P=0.042)。患者术前、术后3月及术后12个月时的腿痛VAS(F=199.51, P<0.001)、腰痛VAS(F=233.90, P<0.001)、ODI(F=199.17, P<0.Objective To investigate the changes of thickness and area of the ligamentum flavum after lateral lumbar interbody fusion(LLIF)for lumbar degenerative diseases.Methods From 2019 to 2021,a total of 54 patients with lumbar degenerative diseases who underwent LLIF combined with percutaneous pedicle screw internal fixation were retrospectively analyzed.There were 9 males and 45 females,aged 59.46±6.91 years(range,45-76 years),followed up for 14.69±6.87 months(range,12-33 months).The disc height(DH),midsagittal canal diameter(CD),dural sac axial cross-sectional area(DCSA),ligamentum flavum area(LFA)and ligamentum flavum thickness(LFT)before and after surgery and at the last follow-up were evaluated and compared.Pearson correlation analysis was used to assess the relationship between the amount of change in the DCSA and LFA in the immediate postoperative period and at the last follow-up,as well as the correlation between the two and the amount of change in the DH.The data of patients at the last follow-up of 12 months after operation were extracted.Pearson correlation was used to evaluate the changes in DCSA and LFA at the last follow-up and the visual analogue scale(VAS)of low back pain and leg pain and Oswestry disability index(ODI)at 1 year after surgery.Results All patients were followed up for 14.69±6.87 months(range,12-33 months).The differences in DH(F=354.93,P<0.001),sagittal CD(F=44.78,P<0.001)and DCSA(F=130.97,P<0.001)before,immediately after surgery and at the last follow-up were statistically significant.The DH,sagittal CD,and DCSA immediate after surgery and last follow-up were higher than those before surgery(P<0.05).The differences in LFA(F=51.59,P<0.001)and bilateral LFT(F=53.49,P<0.001;F=50.53,P<0.001)before and after surgery and at the last follow-up were statistically significant,and both LFA and bilateral LFT at immediate after surgery and last follow-up were smaller than those before surgery(P<0.05).Pearson correlation analysis showed that the change of DH immediately after surgery was moderatel

关 键 词：脊柱疾病 脊椎融合术 黄韧带 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]