椎间孔镜联合经皮棘突间动态固定与常规融合内固定治疗腰椎退行性疾病的疗效对比

发布时间：2018-08-16 09:04

【摘要】：[目的]对比椎间孔镜(PTED)联合经皮棘突间动态固定(In-Space)与常规融合内固定(PLIF)治疗腰椎退行性疾病的临床疗效。[方法]选取2012年1月~2013年1月本科收治的65例病例,电脑随机将31例患者分入In-Space组,34例患者分入PLIF组,随访12个月,比较两组手术时间、术中出血量、住院天数、并发症发生率等。分别在术前、术后1个月、术后3个月、术后6个月、术后12个月进行视觉疼痛模拟评分(VAS)评分、Oswsstry功能障碍指数(ODI)评价手术效果。于各随访时间点分别摄腰椎正、侧位及动力位X线片,测量手术节段及上邻节段腰椎活动度(ROM),评价末次随访腰椎稳定性变化。[结果]In-Space组出血量、住院天数明显少于PLIF组(P0.01),两组手术时间差异无统计学意义(P0.05)。In-Space组和PLIF组并发症发生率分别为6.45%(2/31)和26.47%(9/34),差异具有统计学意义(P0.05)。两组术后腰腿痛VAS评分、ODI指数均较术前明显改善(P0.01),但PLIF组术后1个月及3个月腰痛VAS评分高于In-Space组(P0.05)。In-Space组手术节段、上邻节段ROM术前与末次随访相比差异无统计学意义(P0.05)。末次随访中,In-Space组手术节段ROM明显大于PLIF组(P0.01),PLIF组上邻节段ROM明显大于术前(P0.05)及In-Space组(P0.05)。[结论]PTED联合InSpace与PLIF治疗腰椎退行性疾病均可取得满意的临床疗效,但前者在完成良好减压的同时,具有明显的微创优势,且较好地维持脊柱活动度及稳定性,是理想的微创手术方法。
[Abstract]:[objective] to compare the clinical effects of intervertebral foramen (PTED) combined with percutaneous dynamic interspinous process fixation (In-Space) and conventional fusion internal fixation (PLIF) in the treatment of lumbar degenerative diseases. [methods] from January 2012 to January 2013, 65 cases were randomly divided into In-Space group (34 cases) and PLIF group (34 cases). The two groups were followed up for 12 months. Incidence of complications, etc. Visual pain analogue score (VAS) and Oswsstry dysfunction Index (ODI) were performed before, 1 month, 3 months, 6 months and 12 months after operation respectively. Lumbar vertebrae were taken at different follow-up time points. The lumbar stability was evaluated by (ROM), for the lumbar motion of the operative segment and the upper adjacent segment of lumbar vertebrae. [results] the amount of bleeding in the In-Space group was significantly less than that in the PLIF group (P0.01). There was no significant difference in the operative time between the two groups (P0.05). The incidence of complications in the In-Space group and PLIF group was 6.45% (2 / 31) and 26.47% (9 / 34), respectively. The difference was statistically significant (P0.05). The VAS scores of lumbar and leg pain in the two groups were significantly improved compared with those before operation (P0.01), but the VAS scores in the PLIF group were higher than those in the In-Space group at 1 month and 3 months after operation (P0.05). There was no significant difference between the upper adjacent segment ROM and the last follow-up (P0.05). In the last follow-up, the ROM of the operative segment in the In-Space group was significantly higher than that in the PLIF group (P0.01). The ROM of the upper adjacent segment in the PLIF group was significantly higher than that in the preoperative group (P0.05) and the In-Space group (P0.05). [conclusion] PTED combined with InSpace and PLIF can achieve satisfactory clinical effect in the treatment of lumbar degenerative diseases, but the former has obvious advantages of minimally invasive operation, and maintains the range of spinal movement and stability in the treatment of lumbar degenerative diseases. It is an ideal method of minimally invasive surgery.
【作者单位】：武警河南总队医院脊柱外科;
【分类号】：R687.3

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