多节段腰椎退行性疾病非融合与融合固定比较  

Comparison of non-fusion versus fusion pedicle screw fixation for multilevel lumbar degenerative disease

作　　者：刘涛 俞兴[2] 关健斌 杨永栋[2] 杨济洲[2] 赵赫[2] 曲弋[2] 王逢贤[2] 赵子义[2] 赵丁岩 LIU Tao;YU Xing;GUAN Jian-bin;YANG Yong-dong;YANG Ji-zhou;ZHAO He;QU Yi;WANG Feng-xian;ZHAO Zi-yi;ZHAO Ding-yan(First Clinical Medical College,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Orthopedics,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing100700,China)

机构地区：[1]北京中医药大学第一临床医学院,北京100700 [2]北京中医药大学东直门医院骨科,北京100700

出　　处：《中国矫形外科杂志》2023年第13期1164-1170,共7页Orthopedic Journal of China

基　　金：潍坊奥精仿生骨多中心临床研究项目(编号:HX-DZM-2018010)。

摘　　要：[目的]比较多节段腰椎退行性疾病椎弓钉非融合与融合固定的临床效果。[方法]2018年1月—2019年12月62例三节段腰椎退行性疾病患者纳入本研究,根据术前医患沟通结果,30例采用椎管减压非融合椎弓钉-PEEK棒固定,32例采用减压常规钉-棒融合固定。比较两组围手术期、随访及影像结果。[结果]两组切口长度、术后引流量、切口愈合等级、下地行走时间、住院时间的差异均无统计学意义(P<0.05),但是非融合组手术时间[(172.2±48.7)min vs(216.5±75.4)min,P<0.05]及术中出血量[(216.5±75.4)ml vs(268.8±94.5)ml,P<0.05]显著优于融合组。所有患者平均随访(28.1±3.8)个月,随时间推移,两组患者腰痛VAS评分、腿痛VAS评分、ODI指数及LSDI评分均显著改善(P<0.05)。相应时间点,两组间腰痛VAS评分、腿痛VAS评分、ODI指数的差异均无统计学意义(P>0.05)。术后12个月[(7.2±4.1)vs(9.7±3.9),P<0.05]及末次随访时[(6.8±3.7)vs(8.9±3.6),P<0.05]非融合组的LSDI评分显著优于融合组。影像方面,术前两组间上位椎间ROM、固定节段ROM、腰椎整体ROM、Pfirrmann分级的比较差异均无统计学意义(P>0.05)。术后12个月及末次随访时非融合组上位椎间活动度均显著小于融合组[(5.2±3.4)°vs(6.3±3.2)°,P<0.001;(5.3±3.7)°vs(6.7±3.8)°,P<0.001]。术后3、12个月和末次随访时,非融合组固定节段ROM均显著大于融合组[(8.4±3.6)°vs(2.1±0.9)°,P<0.001;(9.7±2.3)°vs(1.4±0.5)°,P<0.001;(11.5±2.9)°vs(0.9±0.4)°,P<0.001]。末次随访时腰椎整体活动度显著大于融合组[(26.2±6.8)vs(23.4±3.5),P=0.012]。末次随访时,非融合组上邻椎间隙Pfirrmann分级显著优于融合组[Ⅰ/Ⅱ/Ⅲ/Ⅳ/Ⅴ:(5/15/7/3/0)vs(4/12/11/4/2),P=0.014]。[结论]非融合术后能保留固定节段部分活动度、患者腰背部僵硬感较轻,对邻近节段椎间盘退变影响相对较小。[Objective]To compare the clinical outcomes of non-fusion versus fusion pedicle screw fixation for multi-segment lumbar degenerative diseases.[Methods]A total of 62 patients with three-segment lumbar degenerative diseases were included in this study from January 2018 to December 2019.According to preoperative doctor-patient communication,30 patients were treated with spinal decompres⁃sion and non-fusion pedicle screw fixation with PEEK rod,while the remaining 32 patients received decompression and conventional pedi⁃cle screw-rod fixation and fusion.The perioperative,follow-up and imaging data were compared between the two groups.[Results]Although there were no significant differences in incision length,postoperative drainage volume,incision healing grade,postoperative walking time and hospital stay between the two groups(P<0.05),the non-fusion group proved significantly superior to the fusion group in terms of opera⁃tive time[(172.2±48.7)min vs(216.5±75.4)min,P<0.05]and intraoperative blood loss[(216.5±75.4)ml vs(268.8±94.5)ml,P<0.05].With time of follow-up lasted for(28.1±3.8)months on a mean,the VAS scores for back pain and leg pain,as well as ODI and LSDI score signifi⁃cantly improved in both groups(P<0.05).Despite of the fact that there were no significant differences in the VAS scores for lumbago and leg pain as well as ODI score between the two groups at any time points accordingly(P>0.05),the non-fusion group was significantly superior to the fusion group in LSDI score 12 months postoperatively[(7.2±4.1)vs(9.7±3.9),P<0.05]and at the latest follow-up[(6.8±3.7)vs(8.9±3.6),P<0.05].Radiographically,there were no statistically significant differences in preoperative upper adjacent segment range of motion(ROM),fixed segment ROM,total lumbar ROM and Pfirrmann grade for degeneration of the upper adjacent intervertebral disc between the two groups(P<0.05).However,the non-fusion group had significantly less ROM of the upper adjacent segment at 12 months postoperatively and the latest follow-up[(5.2�

关 键 词：腰椎退行性疾病 聚醚醚酮棒 钛棒 非融合固定 邻近节段退变 

分 类 号：R681.5[医药卫生—骨科学]