椎旁肌间隙入路选择性减压及短节段融合术对多节段腰椎管狭窄并腰椎失稳患者术后疼痛程度及腰椎功能的影响  

Effect of paravertebral space approach selective decompression and short-level fusion on postoperative pain and lumbar function in patients with multilevel lumbar spinal stenosis and lumbar instability

作　　者：吕超 马胜利 赵强 Lv Chao;Ma Sheng-li;Zhao Qiang(Department of Orthopedics,Xinyang Third People's Hospital,Xinyang 464000,Henan,China;Department of Orthopedics,Xinyang Central Hospital,Xinyang 464000,Henan,China)

机构地区：[1]信阳市第三人民医院骨科,河南信阳464000 [2]信阳市中心医院骨科,河南信阳464000

出　　处：《四川生理科学杂志》2024年第1期174-177,共4页Sichuan Journal of Physiological Sciences

摘　　要：目的:探究短节段融合联合椎旁肌间隙(Wiltse)入路选择性减压治疗多节段腰椎管狭窄(Lumbar Spinal Stenosis,LSS)并腰椎失稳(Lumbar segmental instability,LSI)患者的效果。方法:选取我院2020年2月至2022年12月间收治的174例多节段LSS并LSI患者,按随机数字表法分成研究组和对照组(n=87)。研究组接受短节段融合联合Wiltse入路选择性减压术治疗,对照组接受长节段融合联合后正中入路全狭窄节段减压治疗。对比两组手术指标、手术效果、椎间融合情况,手术前后采用日本矫形外科学会(Japanese Orthopaedic Association,JOA)评分、视觉模拟评分法(Visual Analogue Score,VAS)评分评估腰椎功能、疼痛程度,并以酶联免疫法测定应激指标,如肾素(Renin,R)、乳酸脱氢酶(Lactate dehydrogenase,LDH)、血管紧张素Ⅱ(Angiotensin Ⅱ,AngⅡ)、肌红蛋白(Myoglobin,MYO)水平,同时记录并发症发生率。结果:与对照组对比,研究组术后引流量、术中失血量更少,手术耗时更短(P<0.05);与对照组对比,术后1 m、3 m研究组JOA评分更高,VAS评分更组低(P<0.05);与对照组手术优良率88.51%(77/87)对比,研究组97.70%(85/87)更高,与对照组融合节段100.00%(207/207)对比,研究组44.81%(95/212)更低(P<0.05);与对照组对比,术后1 d、3 d研究组血清R、LDH、AngⅡ、MYO水平均更低(P<0.05);与对照组并发症总发生率16.09%(14/87)对比,研究组3.45%(3/87)更低(P<0.05)。结论:短节段融合联合Wiltse入路选择性减压术治疗多节段LSS并LSI患者效果显著,可优化手术指标,减少椎间融合及并发症,减轻疼痛感,提高腰椎功能,且具备微创特点。Objective:To explore the effect of short-level fusion combined with paraspinal space(Wiltse)approach for selective decompression in the treatment of multilevel lumbar spinal stenosis(LSS)with lumbar instability(LSI).Methods:A total of 174 patients with multilevel LSS and LSI admitted to our hospital from February 2020 to December 2022 were selected and divided into a study group and a control group according to the random number table method(n=87).The study group received short-level fusion combined with the Wiltse approach for selective decompression,while the control group received long-level fusion combined with a posterior median approach for total stenosis decompression.The two groups'surgical indexes,surgical effects,and intervertebral fusion were compared.Japanese Orthopaedic Association(JOA)Score and Visual Analogue Score(VAS)were used before and after surgery to evaluate the lumbar function and pain degree.Stress indexes,such as Renin(R),Lactate dehydrogenase(LDH),AngiotensinⅡ(AngⅡ),and Myoglobin(MYO)levels were evaluated by enzyme-linked immunoassay.And complication rates were recorded.Results:Compared with the control group,the postoperative drainage volume and intraoperative blood loss in the study group were less,and the operation time was shorter(P<0.05).Compared with the control group,the JOA score of the study group was higher,and the VAS score of the group was lower(P<0.05).Compared with 88.51%(77/87)in the control group,the rate of excellent and good surgery was 97.70%(85/87)higher in the study group,and 44.81%(95/212)lower in the study group than 100.00%(207/207)in the control group(P<0.05).Compared with the control group,serum levels of R,LDH,AngⅡ,and MYO were lower in the postoperative groups(P<0.05).The total complication rate in the study group was 3.45%(3/87),which is lower than that in the control group(16.09%(14/87))(P<0.05).Conclusions:Short-level fusion combined with the Wiltse approach for selective decompression in the treatment of patients with multi-level LSS and LSI has sign

关 键 词：椎旁肌间隙 腰椎管狭窄 腰椎失稳 应激 

分 类 号：R68[医药卫生—骨科学]