保留后方韧带复合体改良后路腰椎间融合术治疗腰椎退行性疾病的疗效观察  

Clinical observation of modified posterior lumbar interbody fusion with preservation of posterior ligament complex in treatment of lumbar degenerative diseases

作　　者：周政纲 朱建克 沈世彬 魏雪 黄浩然 李亮 张梦娟 ZHOU Zhengang;ZHU Jianke;SHEN Shibin;WEI Xue;HUANG Haoran;LI Liang;ZHANG Mengjuan(Department of Spinal Surgery,Chengyang District People's Hospital,Qingdao,Shandong 266109,China;不详)

机构地区：[1]青岛市城阳区人民医院脊柱外科,山东266109 [2]青岛市城阳区人民医院手术室,山东266109 [3]青岛市城阳区人民医院肾内科,山东266109 [4]青岛市市立医院本部骨关节与运动医学科,山东266100

出　　处：《中国骨与关节损伤杂志》2025年第3期252-257,共6页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察保留后方韧带复合体改良后路腰椎间融合术治疗腰椎退行性疾病的临床疗效。方法回顾性研究纳入自2019-06—2022-12手术治疗的49例腰椎退行性疾病,改良组27例行保留后方韧带复合体改良后路腰椎间融合术,常规组22例行传统后路腰椎间融合术。比较两组手术时间、术中出血量、引流量、术后至下床时间、住院时间、疗效评定结果(改良Macnab标准)、术后慢性下腰痛发生率、术后邻近节段退行性改变发生率,以及术后疼痛VAS评分、ODI指数、腰椎矢状位Cobb角。结果49例均获得随访,随访时间12~21个月,平均15.4个月。改良组与常规组手术时间、术中出血量、引流量、术后至下床时间、住院时间、疗效评定结果差异无统计学意义,术后1周、术后12周疼痛VAS评分和ODI指数差异无统计学意义,术后邻近节段退行性改变发生率差异无统计学意义(P>0.05)。改良组术后慢性下腰痛发生率低于常规组,末次随访时疼痛VAS评分、ODI指数均低于常规组,末次随访时腰椎矢状位Cobb角维持良好且明显大于常规组,差异有统计学意义(P<0.05)。结论保留后方韧带复合体改良后路腰椎间融合术治疗腰椎退行性疾病不会增加手术操作难度和风险,术后远期患者椎旁肌和腰椎功能恢复更好,降低术后慢性下腰痛的发生率,同时可以较好地维持腰椎的生理曲度。Objective To observe the clinical efficacy of modified posterior lumbar interbody fusion with preserved posterior ligament complex in the treatment of lumbar degenerative diseases.Methods A retrospective study included 49 cases of lumbar degenerative diseases surgically treated from June 2019 to December 2022.Twenty-seven cases in the modified group underwent modified posterior lumbar interbody fusion with posterior ligament complex preservation,and 22 cases in the conventional group underwent traditional posterior lumbar interbody fusion.The operation time,intraoperative blood loss,drainage volume,postoperative time to get out of bed,hospital stay,curative effect evaluation results(modified Macnab standard),postoperative chronic low back pain incidence,postoperative degenerative changes in adjacent segments,postoperative pain VAS score,ODI index and sagittal Cobb angle of lumbar vertebra were compared between the two groups.Results All 49 cases were followed up for 12-21 months,with an average of 15.4 months.There was no statistically significant difference between the modified group and the conventional group in operation time,intraoperative blood loss,drainage volume,postoperative time to get out of bed,hospital stay,and curative effect evaluation results.There was no statistically significant difference in pain VAS score and ODI index at 1 and 12 weeks after operation,and there was no statistically significant difference in the incidence of degenerative changes in adjacent segments after operation(P>0.05).The incidence of postoperative chronic low back pain in the modified group was lower than that in the conventional group,and the pain VAS score and ODI index at the last follow-up were lower than those in the conventional group.At the last follow-up,the sagittal Cobb angle of lumbar spine was maintained well and significantly greater the modified group than that in the conventional group,and the difference was statistically significant(P<0.05).Conclusion Modified posterior lumbar interbody fusion with poster

关 键 词：腰椎退行性疾病 后路腰椎间融合术 后方韧带复合体 慢性下腰痛 邻近节段退行性改变 

分 类 号：R681.5[医药卫生—骨科学]