保留近端上半椎板减压融合术治疗腰椎退变性疾病的疗效及其对预防邻近节段退变的作用  

Clinical efficacy and prevention of adjacent segment degeneration in the treatment of lumbar degenerative diseases through decompression and fusion preserving proximal upper laminae

作　　者：陈豪杰 周庆双 蒲小江 王斯年 朱泽章[1] 邱勇[1] 王斌[1] 孙旭[1] Chen Haojie;Zhou Qingshuang;Pu Xiaojiang;Wang Sinian;Zhu Zezhang;Qiu Yong;Wang Bin;Sun Xu(Division of Spine Surgery,Department of Orthopaedic Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China;Division of Spine Surgery,Department of Orthopaedic Surgery,Nanjing Drum Tower Hospital Clinical College of Jiangsu University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008 [2]江苏大学鼓楼临床医学院骨科脊柱外科,南京210008

出　　处：《中华骨科杂志》2023年第20期1343-1353,共11页Chinese Journal of Orthopaedics

基　　金：江苏省医学创新中心(CXZX202214)。

摘　　要：目的探讨保留近端上半椎板减压腰椎内固定融合术治疗腰椎退变性疾病的疗效及其对预防邻近节段退变(adjacent segment degeneration,ASD)的作用。方法回顾性分析2018年3月至2020年2月在南京大学医学院附属鼓楼医院采用保留近端上半椎板、上半棘突和近侧棘上、棘间韧带减压术联合内固定融合治疗且获得2年以上随访的腰椎退变性腰椎管狭窄患者124例(保留组),2016年1月至2018年2月行腰椎全椎板切除减压术联合内固定融合治疗的腰椎退变性腰椎管狭窄患者130例作为对照(全切组)。保留组男60例、女64例,年龄(58.3±10.3)岁,巨大腰椎间盘突出50例、腰椎间盘突出伴骨化11例、单纯腰椎管狭窄10例、退变性腰椎滑脱53例;全切组男62例、女68例,年龄(59.6±9.2)岁,巨大腰椎间盘突出51例、腰椎间盘突出伴骨化13例、单纯腰椎管狭窄11例、退变性腰椎滑脱55例。对两组患者手术节段数量、手术时间、术中出血量、术后住院时间、并发症、椎板保留范围、切除范围、硬膜囊面积及矢状面参数进行比较。末次随访时评估融合情况、邻椎稳定性及邻近节段退变(adjacent segment degeneration,ASD)发生率。使用Oswestry功能障碍指数(Oswestry disability index,ODI)、腰腿痛视觉模拟评分(visual analogue scale,VAS)评价临床疗效。结果保留组随访时间为(30.5±5.4)个月,全切组为(31.0±5.8)个月,差异无统计学意义(t=0.63,P=0.528)。在单节段手术患者中,保留组的手术时间[(173.6±47.3)min]、出血量[(351.7±102.0)ml]和术后住院时间[(7.8±3.1)d]均低于全切组[分别为(196.2±34.2)min、(401.9±97.2)ml、(9.9±3.6)d],差异有统计学意义(t=2.93,P=0.004;t=2.69,P=0.008;t=3.26,P<0.001)。两组硬膜囊面积术后均得到明显改善,但保留组的椎板切除范围[(22.8±4.5)mm]小于全切组[(29.5±4.8)mm],差异有统计学意义(t=7.62,P<0.001)。保留组双节段与三节段患者的上述指标均优Objective To investigate the clinical results of decompression preserving proximal upper laminae combined with lumbar instrumental fusion in the treatment of lumbar degenerative diseases and the prevention of adjacent segment degeneration(ASD).Methods A retrospective analysis was conducted on 124 patients(the reserved group)with lumbar degeneration who underwent compression preserving proximal upper laminae combined with fusion surgery involving upper half of the lamina,upper half of the spinous process,adjacent facets,and interspinous ligament at Nanjing Drum Tower Hospital between March 2018 and February 2020.These patients were followed up for more than 2 years.Additionally,130 patients who underwent traditional total laminectomy decompression combined with fusion surgery from January 2016 to February 2018 were selected as the control group(total laminectomy group).In the reserved group,there were 60 males and 64 females,aged 58.3±10.3 years,including 50 cases of giant lumbar disc herniation,11 cases of lumbar disc herniation with ossification,10 cases of simple lumbar spinal stenosis,and 53 cases of degenerative lumbar spondylolisthesis.Total laminectomy group comprised 62 males and 68 females,aged 59.6±9.2 years,with 51 cases of giant lumbar disc herniation,13 cases of lumbar disc herniation with ossification,11 cases of simple lumbar spinal stenosis,and 55 cases of degenerative lumbar spondylolisthesis.The number of operative segments,operative time,intraoperative blood loss,postoperative hospital stay,complications,extent of laminectomy,dural sac area,and sagittal spinopelvic parameters were compared between the two groups.Fusion status,adjacent segment stability,and the incidence of ASD were assessed at the last follow-up.Oswestry disability index(ODI)and visual analogue scale(VAS)for back and leg were used to evaluate clinical effectiveness.Results The follow-up time was 30.5±5.4 months in the reserved group and 31.0±5.8 months in total laminectomy group,and the difference was not statistically signi

关 键 词：腰椎 脊柱融合术 椎间盘退行性变 椎管狭窄 

分 类 号：R687.3[医药卫生—骨科学]