斜向腰椎椎间融合术治疗腰椎退行性疾病的临床疗效

发布时间：2018-05-08 11:01

本文选题：斜向腰椎椎间融合术 + 腰椎退行性疾病　；参考：《中国脊柱脊髓杂志》2017年09期

【摘要】：目的 :探讨应用斜向腰椎椎间融合术治疗腰椎退行性疾病的临床疗效。方法 :对2015年10月~2016年5月应用斜向腰椎椎间融合术治疗的24例腰椎退行性疾病患者进行回顾性分析,男8例,女16例,年龄44~88岁,平均62.3±12.0岁,手术节段36节。观察手术时间、出血量、术后并发症,比较术前、术后1周、末次随访时腰痛JOA评分、Oswestry功能障碍指数(ODI)情况及X线片上手术节段椎间隙高度(intervertebral disc height,IDH)和椎间孔高度(intervertebral foramen height,IFH)变化。结果 :平均手术时间135±21.0min(100~170min),平均术中出血量163.3±54.9ml(100~300ml)。平均随访时间15.8±2.2个月(13~20个月)。末次随访时7例患者发生融合器下沉,下沉节段10节,其中2例患者未行后路椎弓根螺钉固定,2例患者术中有明确终板损伤;3例出现一过性大腿前方疼痛,1例出现下肢乏力,1周后恢复正常。所有患者症状在随访过程中均逐渐改善,术前、术后1周及末次随访时平均腰痛JOA评分分别为11.2±1.9、19.4±1.3、25.0±0.72,术后1周与末次随访与术前比较均有统计学差异(P0.01);平均ODI分别为(68.5±5.9)%、(45.6±5.65)%、(12.2±5.1)%,术后1周与末次随访与术前比较均有统计学差异(P0.01);平均椎间隙高度分别为9.16±2.7mm、12.7±2.6mm、10.8±3.0mm,术后1周与术前比较有统计学差异(P0.01),末次随访与术前比较无统计学差异(P0.05);平均椎间孔高度16.9±3.7mm、20.7±3.7mm、18.1±4.2mm,术后1周与术前比较有统计学差异(P0.01),末次随访与术前比较无统计学差异(P0.05)。结论:斜向腰椎椎间融合术近期疗效好、安全性高,能有效治疗腰椎退行性疾病,远期疗效还需经过大样本长期的随访和研究。
[Abstract]:Objective: to investigate the clinical effect of oblique lumbar interbody fusion in the treatment of lumbar degenerative diseases. Methods: 24 cases of lumbar degenerative diseases treated by oblique lumbar interbody fusion from October 2015 to May 2016 were retrospectively analyzed. There were 8 males and 16 females, aged 44 to 88 years (mean 62.3 卤12.0 years). The time of operation, the amount of bleeding and postoperative complications were observed. The changes of JOA score and intervertebral disc height of intervertebral disc and intervertebral foramen were compared before operation, 1 week after operation and at the last follow-up. Results: the average operative time was 135 卤21.0 min and 100 ~ 170 min, and the average intraoperative bleeding was 163.3 卤54.9 ml / 100 ~ 300 ml / L. The mean follow-up time was 15.8 卤2.2 months, 13 ~ 20 months. At the last follow-up, 7 patients suffered from the sinking of the fusion cage and 10 segments of the sinking segment. Among them, 2 cases had no posterior pedicle screw fixation, 2 cases had definite endplate injury during operation, 3 cases had transient anterior thigh pain and 1 case had lower extremity fatigue and recovered to normal after 1 week. The symptoms of all patients were gradually improved during follow-up. The mean JOA score of lumbago was 11.2 卤1.9 卤19.4 卤1.3 卤25.0 卤0.72 at the first week and the last follow-up, respectively. There were significant differences between the first week and the last follow-up after operation compared with those before operation (P 0.01), and the average ODI were 68.5 卤5.9 卤5.6512.2 卤5.1g, respectively. There was a statistical difference between the last follow-up and the last follow-up at the first week after the operation compared with that before operation. The average height of intervertebral space was 9.16 卤2.7mm vs 12.7 卤2.6mm / 10.8 卤3.0mm respectively. There was a significant difference between postoperation and pre-operation (P 0.01). There was no significant difference between the last follow-up and pre-operation (P 0.05); the average height of intervertebral foramen was 16.9 卤3.7mm (18.1 卤4.2mm). There was significant difference between postoperation and postoperation (P 0.01a), and at the end of operation, there was significant difference in the height of intervertebral foramen (16.9 卤3.7mm, 18.1 卤4.2mm). There was no statistical difference between the follow-up and the preoperative follow-up (P 0.05). Conclusion: oblique lumbar interbody fusion is effective in the treatment of lumbar degenerative diseases.
【作者单位】：广东省人民医院骨科;
【基金】：广东省省级科技计划项目(编号:2014A020212402)
【分类号】：R687.3

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