显微镜下微创保留后方韧带复合体及腰椎置钉融合治疗腰椎退变性疾病

发布时间：2018-10-09 10:05

【摘要】：背景:在后路腰椎融合过程中切除后方韧带复合体,可能会影响相邻节段的运动和负荷规律,导致相邻节段出现术后失稳,使其成为邻近节段退变的重要因素之一。目的:探讨显微镜下微创保留后方韧带复合体的后路腰椎置钉融合治疗腰椎退变性疾病的可行性。方法:纳入36例单节段腰椎退变性疾病患者,其中17例进行显微镜下保留后方韧带复合体的后路腰椎融合手术,同时以螺钉固定,作为试验组;另19例进行切除后方韧带复合体的传统后路腰椎融合手术,同时以螺钉固定,作为对照组。治疗前及治疗后3个月,评估患者目测类比评分与Oswestry功能障碍指数;随访期间,X射线观察邻近节段退变情况。结果与结论:两组治疗后3个月的目测类比评分与Oswestry功能障碍指数均明显低于治疗前(P0.01),试验组治疗后3个月的目测类比评分与Oswestry功能障碍指数明显低于对照组(P0.01);随访期间,试验组2例出现邻近节段退变,对照组8例出现邻近节段退变,X射线片显示内固定稳定,无椎弓根钉松动、断裂或脱出等并发症发生;结果表明显微镜下微创保留后方韧带复合体的后路腰椎置钉融合,可有效缓解腰椎退变患者的疼痛和功能障碍,减少邻近节段退变的发生。
[Abstract]:Background: removal of posterior quadrate ligament complex in the process of posterior lumbar fusion may affect the movement and load of adjacent segments and lead to postoperative instability of adjacent segments, which may become one of the important factors of adjacent segment degeneration. Objective: to investigate the feasibility of microinvasive posterior lumbar nail fusion for lumbar degenerative disease. Methods: Thirty-six patients with single segmental lumbar degenerative disease were included. 17 of them underwent posterior lumbar fusion surgery with posterior ligamentous complex retained under microscope, and were treated with screw fixation as experimental group. The other 19 cases were treated with posterior lumbar fusion with screw fixation. The visual analogue score and Oswestry dysfunction index were evaluated before and 3 months after treatment, and the adjacent segment degeneration was observed by X-ray during the follow-up period. Results and conclusion: visual analogue score and Oswestry dysfunction index in both groups were significantly lower than those before treatment (P0.01), visual analogue score and Oswestry dysfunction index in experimental group were significantly lower than those in control group 3 months after treatment (P0.01), during follow-up period, the scores of visual analogue and Oswestry dysfunction were significantly lower in the experimental group than in the control group (P0.01). In the test group, the adjacent segment degeneration occurred in 2 cases and the adjacent segment degeneration in 8 cases in the control group. There were no complications such as pedicle screw loosening, fracture or prolapse. The results showed that microinvasive posterior lumbar screw fusion with posterior ligamentum complex preservation could effectively relieve pain and dysfunction in patients with lumbar degenerative disease and reduce the incidence of adjacent segment degeneration.
【作者单位】：天津市天津医院;
【基金】：国家自然科学基金(81472140) 天津市卫生局攻关课题(15KG124)~~
【分类号】：R687.3

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