Wiltse入路动态系统内固定与腰椎后路椎间融合术治疗腰椎椎间盘突出症的长期疗效  

Long-term effects of Wiltse approach dynamic system fixation and posterior lumbar interbody fusion for treatment of lumbar disc herniation

作　　者：刘杰 金新蒙 王雷[2] 张金喜 Liu Jie;Jin Xinmeng;Wang Lei;Zhang Jinxi(Department of Orthopaedics,Ninth People’s Hospital of Hangzhou,Hangzhou 311225,Zhejiang,China;Department of Orthopaedics,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]杭州市第九人民医院骨科,杭州311225 [2]上海交通大学附属第一人民医院骨科,上海200080

出　　处：《脊柱外科杂志》2023年第6期375-380,共6页Journal of Spinal Surgery

摘　　要：目的比较Wiltse入路动态系统(Dynesys)内固定与腰椎后路椎间融合内固定术(PLIF)治疗腰椎椎间盘突出症(LDH)的长期临床疗效。方法2009年6月—2012年6月,上海交通大学附属第一人民医院采用Wiltse入路Dynesys内固定治疗LDH患者30例(Dynesys组),与同期采用PLIF治疗的30例LDH患者(PLIF组)作比较。记录2组围手术期情况,以及手术前后的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、手术节段和上位邻近节段的椎间盘高度(DH)及椎间活动度(ROM)。并采用美国加州大学洛杉矶分校(UCLA)分级系统评估邻近节段退行性变(ASD)情况。结果2组患者手术顺利完成,并获得至少9年的随访。Dynesys组手术时间、术中出血量、住院时间显著少于PLIF组,差异均有统计学意义(P<0.05)。术后3年及末次随访时,2组VAS评分和ODI较术前改善,差异均有统计学意义(P<0.05);组间差异无统计学意义(P>0.05)。末次随访时2组手术节段及上位邻近节段DH较术前无显著改变,差异无统计学意义(P>0.05)。末次随访时,2组手术节段ROM较术前显著降低,PLIF组上位邻近节段ROM较术前显著增加,差异均有统计学意义(P<0.05)。末次随访时,Dynesys组手术节段ROM大于PLIF组,而上位邻近节段ROM低于PLIF组,差异均有统计学意义(P<0.05)。Dynesys组邻近节段UCLA分级显著优于PLIF组,差异有统计学意义(P<0.05)。结论Wiltse入路Dynesys内固定和PLIF治疗LDH均能获得满意的长期疗效,但前者手术创伤更小,且保留了腰椎后方韧带复合体和固定节段ROM,有助于延缓ASD发生。Objective To compare the long-term clinical efficacy of Wiltse approach dynamic system(Dynesys)fixation and posterior lumbar interbody fusion(PLIF)in the treatment of lumbar disc herniation(LDH).Methods From June 2009 to June 2012,30 LDH patients were treated with Wiltse approach Dynesys fixation(Dynesys group)in the First People’s Hospital Affiliated to Shanghai Jiao Tong University,and other 30 LDH patients treated with PLIF(PLIF group)at the same period.The perioperative conditions of the 2 groups were recorded,as well as preoperative and postoperative pain visual analogue scale(VAS)scores,Oswestry disability index(ODI),disc height(DH)and intervertebral range of motion(ROM)of the operative segment and superior adjacent segments.The University of California at Los Angeles(UCLA)grading system was used to assess adjacent segment degeneration(ASD).Results Both 2 groups of patients successfully completed surgery and received at least 9 years of follow-up.The operation time,intraoperative blood loss,and hospital stay in the Dynesys group were significantly shorter than those in the PLIF group,with a statistically significant difference(P<0.05).At postoperative 3 years and the final follow-up,the VAS score and ODI in the 2 groups were significantly improved compared with those before surgery,all with a statistical significance(P<0.05),but there was no statistically significant difference between the 2 groups(P>0.05).Compared with the pre-operation,there was no significant change in DH of the operative segment and superior adjacent segment in both groups at the final follow-up(P>0.05);at the final follow-up,the ROM of the operative segment in both groups decreased significantly,while the ROM of the superior adjacent segment in the PLIF group increased significantly,all with a significant difference(P<0.05);at the final follow-up,the ROM of the operative segment in the Dynesys group was greater than that in the PLIF group,while the ROM of the superior adjacent segment was significantly lower than that in the PLIF gro

关 键 词：腰椎 椎间盘移位 内固定器 脊柱融合术 

分 类 号：R681.533.1[医药卫生—骨科学]