经椎间孔腰椎椎体间融合术治疗单节段腰椎管狭窄症的中长期疗效和椎旁肌及相邻关节突关节变化  

Mid-to long-term clinical efficacy of transforaminal lumbar interbody fusion for the treatment of single-segment lumbar spinal stenosis and changes in paraspinal muscles and adjacent segment facet joints after operation

作　　者：庞大明 尹鹏 杨晋才[1] 海涌[1] 范哲轩 黄继旋 PANG Daming;YIN Peng;YANG Jincai(Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京市100020

出　　处：《中国脊柱脊髓杂志》2024年第4期372-379,共8页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探究单节段腰椎管狭窄症患者接受经皮内镜下经椎间孔腰椎椎体间融合术(PE-TLIF)的临床疗效和手术节段术后椎旁肌及相邻节段关节突关节的变化。方法:回顾性分析首都医科大学附属北京朝阳医院2017年3月~2019年3月收治的28例行PE-TLIF治疗的L4/5单节段腰椎管狭窄症患者,其中男性12例,女性16例,年龄58.0±8.7岁(41~79岁),随访40.7±3.6个月(36~58个月)。收集术前和术后1周、3个月、12个月及末次随访时腰痛视觉模拟评分(VAS-LBP)、腿痛视觉模拟评分(VAS-LP);术前和术后3个月、12个月及末次随访时Oswestry功能障碍指数(ODI),并比较手术前后的差异。分别于术前和术后12个月、24个月及末次随访时进行CT检查,测量多裂肌(MF)横截面积(CSA)和脂肪浸润(FI)评分,并根据关节突关节退变评分标准评价手术相邻节段关节突关节退变程度,比较术后MF CSA、FI评分、相邻节段关节突关节退变评分与术前的差异。结果:患者术前VAS-LBP为7(7,8)分,术后1周为3(2,3)分,3个月为1(1,2)分,12个月为1(0,2)分,末次随访为1(0,1)分,术后较术前显著性改善(P<0.05);术前VAS-LP为6(5,7)分,术后1周为2(1,3)分,3个月为1(1,2)分,12个月为1(0,1)分,末次随访为0(0,1)分,术后较术前显著性改善(P<0.05);术前ODI为61%(55%,67%),术后3个月为23%(19%,31%),12个月为12%(8.5%,17.5%),末次随访为7%(4%,15.6%),术后较术前显著性改善(P<0.05)。术前MF CSA:557.06±46.72mm^(2),术后12个月547.12±53.31mm^(2)、术后24个月558.35±52.37mm^(2)、末次随访时531.21±56.12mm^(2),术后与术前无统计学差异(P>0.05)。术前FI评分:2(2,3),术后12个月3(2,3)、术后24个月3(2,3)、末次随访时3(3,3),术后与术前无统计学差异(P>0.05)。术前手术上节段关节突关节评分:5(4,6)分,术后12个月手术5(4,6)分、术后24个月5(4,5)分、末次随访时5(4,6)分,术后与术前比较无统计学差异(P>0.05);术前手术下节段关节突关节评分:5(4,6)�Objectives:The purpose of this study was to investigate the clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF)in patients with single-segment lumbar spinal stenosis and explore the changes of paraspinal muscles and adjacent segmental facet joints of operative segement after PE-TLIF.Methods:28 patients with L4/5 lumbar spinal stenosis treated with PE-TLIF in Beijing Chaoyang Hospital from March 2017 to March 2019 were analyzed retrospectively.The patients consisted of 12 males and 16 females with an average age of 58.0±8.7 years(41-79 years)and were followed up for 40.7±3.6 months(36-58 months).The visual analogue scale(VAS)of low back pain(VAS-LBP)and VAS of leg pain(VAS-LP)were collected at pre-operation,postoperative 1-week follow-up,3-month follow-up,12-month follow-up and the final follow-up;Oswestry disability index(ODI)was evaluated at pre-operation,postoperative 3-month follow-up,12-month follow-up and the final follow-up.CT examination was performed at pre-operation,postoperative 12-month follow-up,24-month follow-up and the final follow-up,the cross-sectional area(CSA)and fat infiltration(FI)score of multifidus(MF)were measured,and the degeneration degree of adjacent segmental facet joints was evaluated according to the score of facet joint degeneration.The differences of MF CSA and FI score,as well as adjacent segmental facet joint degeneration were compared between preoperation and postoperation.Results:The VAS-LBP score was 3(2,3)at 1-week follow-up,1(1,2)at 3-month follow-up,1(0,2)at 12-month follow-up,and 1(0,1)at the final follow-up,which was significantly improved compared with the preoperative score of 7(7,8)(P<0.05);the VAS-LP score was 2(1,3)at 1-week follow-up,1(1,2)at 3-month follow-up,1(0,1)at 12-month follow-up,and 0(0,1)at the final follow-up,which were significantly improved compared with the preoperative score of 6(5,7)(P<0.05);The ODI at 3-month follow-up was 23%(19%,31%),at 12-month follow-up was 12%(8.5%,17.5%),and at the final follow-up was

关 键 词：腰椎管狭窄症 经皮内镜下经椎间孔腰椎椎体间融合术 椎旁肌 关节突关节 

分 类 号：R681.5[医药卫生—骨科学] R616.2[医药卫生—外科学]