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腰椎滑脱伴椎管狭窄是一种常见的脊柱疾病,好发于女性,其发病率为0.53%[1]。目前临床上对于该疾病的治疗方式多样,对于病情无进展的病人,可采用保守治疗[2]。而手术治疗方式主要为减压术及融合术[3],后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)常用于腰椎滑脱伴椎管狭窄病人的治疗[4]。本研究回顾性分析该术式分别联合自体骨椎间植骨与椎间钽金属材料cage植骨治疗的滑脱病人,对比其疗效,以指导临床工作中椎间融合方式的选择。现作报道。
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2组年龄、身高、体质量指数(BMI)、性别和手术节段差异均无统计学意义(P>0.05)(见表 1)。2组手术时间、术中出血、术后引流、术后卧床时间差异无统计学意义(P>0.05)(见表 2)。
分组 n 年龄/岁 BMI/(kg/m2) 男 女 手术节段 L4~5 L5~S1 观察组 31 55.39±9.97 26.95±1.07 8 23 12 19 对照组 29 56.59±9.28 26.87±1.00 8 21 16 13 χ2 — 0.48△ 0.30△ 0.02 0.23 P — > 0.05 > 0.05 > 0.05 > 0.05 △示t值 表 1 2组病人年龄、BMI、性别、手术节段比较
分组 n 手术时间/min 术中出血量/mL 术后引流量/mL 术后卧床时间/d 观察组 31 108.65±5.31 152.77±20.32 161.90±15.75 6.00±0.775 对照组 29 110.48±4.04 150.76±16.60 167.69±16.42 6.10±0.673 t — 1.5 0.42 1.39 0.55 P — > 0.05 > 0.05 > 0.05 > 0.05 表 2 2组手术时间、术中出血量、术后引流量、术后卧床时间比较(x±s)
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2组腰椎滑脱程度术前、术后即刻、术后3个月、术后12个月差异均无统计学意义(P>0.05)。2组椎间隙后缘高度术前、术后即刻差异均无统计学意义(P>0.05),术后3、12个月差异均有统计学意义(P < 0.01)。2组腰椎前凸角度术前、术后即刻差异均无统计学意义(P>0.05),术后3个月、12个月比较差异均有统计学意义(P < 0.01)。2组术后即刻、术后3个月、术后12个月腰椎滑脱程度、椎间隙后缘高度、腰椎前凸角度均较术前改善(P < 0.05)(见表 3)。
分组 n 术前 术后即刻 术后3个月 术后12个月 F P MS 组内 腰椎滑脱程度/% 观察组 31 25.48±5.06 13.87±4.95* 14.84±5.08* 15.16±5.08* 36.29 < 0.01 25.430 对照组 29 26.21±4.94 13.79±4.94* 14.14±5.01* 14.48±5.06* 42.57 < 0.01 1 059.100 t — 0.56 0.06 0.54 0.52 — — — P — > 0.05 > 0.05 > 0.05 > 0.05 — — — 椎间隙后缘高度/mm 观察组 31 6.26±1.44 10.42±1.18* 10.48±1.00* 10.13±0.85* 100.18 < 0.01 1.297 对照组 29 6.41±1.76 10.45±1.06* 9.48±1.02*# 8.90±1.24*# 50.65 < 0.01 1.700 t — 0.38 0.10 3.84 4.54 — — — P — > 0.05 > 0.05 < 0.01 < 0.01 — — — 腰椎前凸角度/(°) 观察组 31 54.68±8.32 39.35±4.18* 40.32±3.76* 40.26±3.63* 59.00 < 0.01 28.502 对照组 29 55.31±8.41 40.86±3.91* 45.38±3.28*# 46.83±3.75*# 38.16 < 0.01 27.709 t — 0.29 1.44 5.53 6.89 — — — P — > 0.05 > 0.05 < 0.01 < 0.01 — — — q检验:与术前比较*P < 0.05;与术后即刻比较#P < 0.05 表 3 腰椎滑脱程度、椎间隙后缘高度、腰椎前凸角度比较(x±s)
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2组术后腰部VAS评分术前、术后即刻差异均无统计学意义(P>0.05),3、12个月差异有统计学意义(P < 0.05和P < 0.01)。2组病人术前、术后即刻、术后3个月及术后12个月腿部VAS评分和ODI差异均无统计学意义(P>0.05)。2组术后即刻、术后3个月、术后12个月腰部VAS评分、腿部VAS评分、ODI评分均高于术前(P < 0.05)(见表 4)。
分组 n 术前 术后即刻 术后3个月 术后12个月 F P MS 组内 腰部VAS评分 观察组 31 6.52±0.96 3.13±0.67* 1.90±0.87*# 1.65±0.49*# 262.27 < 0.01 0.592 对照组 29 6.69±1.04 2.86±0.69* 2.34±0.48*# 2.24±0.58*# 245.97 < 0.01 0.531 t — 0.67 1.52 2.41 4.34 — — — P — > 0.05 > 0.05 < 0.05 < 0.01 — — — 腿部VAS评分 观察组 31 7.65±0.49 3.61±0.62* 1.87±0.67*# 1.84±0.37*# 765.40 < 0.01 0.303 对照组 29 7.72±0.65 3.52±0.51* 1.97±0.68*# 1.83±0.83*# 477.95 < 0.01 0.458 t — 0.54 0.65 0.54 0.11 — — — P — > 0.05 > 0.05 > 0.05 > 0.05 — — — ODI评分 观察组 31 17.58±3.01 7.42±1.93* 3.90±2.39*# 3.42±1.98*# 239.46 < 0.01 5.604 对照组 29 18.59±2.56 8.10±1.70* 4.24±1.70*# 3.55±1.86*# 353.93 < 0.01 3.948 t — 1.39 1.46 0.63 0.27 — — — P — > 0.05 > 0.05 > 0.05 > 0.05 — — — q检验:与术前比较*P < 0.05;与术后即刻比较#P < 0.05 表 4 2组腰部、腿部VAS评分、ODI评分比较(x±s; 分)
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随访期间,所有病人均达到骨性愈合,无感染、内固定松动及融合器移位的发生。对照组存在疼痛2例,下肢麻木3例,邻近节段退变2例,不良事件发生率7/29。观察组1例脑脊液漏,2例下肢麻木,肌力下降1例,邻近节段退变1例,不良事件发生率6/31。2组间不良事件发生率比较差异无统计学意义(χ2=0.49, P>0.05)。
后路腰椎椎体间融合术联合不同椎间融合方式治疗单节段腰椎滑脱伴椎管狭窄症疗效比较
Efficacy comparison of the posterior lumbar intervertebral fusion combined with different intervertebral fusion methods in the treatment of single-level lumbar spondylolisthesis complicated with spinal stenosis
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摘要:
目的探讨后路腰椎椎体间融合术(PLIF)联合不同椎间融合术治疗单节段腰椎滑脱症(LS)合并腰椎管狭窄症(LSS)的疗效。 方法回顾性分析60例单节段LS合并LSS,将其分为观察组(钽金属cage+自体骨)31例和对照组(自体骨)29例。记录手术时间、术中出血量、术后引流、术后卧床休息时间。观察视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、腰椎滑脱程度、椎间隙后缘高度、腰椎前凸角度。 结果2组椎间隙后缘高度术前、术后即刻比较差异无统计学意义(P>0.05),术后3、12个月差异均有统计学意义(P < 0.01)。2组腰椎前凸角度术前、术后即刻差异均无统计学意义(P>0.05),术后3、12个月比较差异均有统计学意义(P < 0.01)。2组术后即刻、术后3个月、术后12个月腰椎滑脱程度、椎间隙后缘高度、腰椎前凸角度均明显较术前改善(P < 0.05)。2组术后腰部VAS评分术前、术后即刻差异均无统计学意义(P>0.05),术后3、12个月差异有统计学意义(P < 0.01)。2组病人术前、术后即刻、术后3个月及12个月腿部VAS评分和ODI差异均无统计学意义(P>0.05)。2组术后即刻、术后3个月、术后12个月腰部VAS评分、腿部VAS评分、ODI均优于术前(P < 0.05)。 结论PLIF联合钽金属cage+自体骨移植组维持腰椎前凸角度、腰椎后缘高度,远期腰部疼痛缓解效果优于单纯自体骨移植组。 -
关键词:
- 腰椎滑脱 /
- 腰椎管狭窄 /
- 后路腰椎椎体间融合术 /
- 椎间融合
Abstract:ObjectiveTo investigate the clinical efficacy of posterior lumbar interbody fusion(PLIF) combined with different intervertebral fusion in the treatment of single-segment lumbar spondylolisthesis(LS) complicated with lumbar spinal stenosis(LSS). MethodsThe clinical data of 60 patients with LS complicated with LSS were retrospectively analyzed, and the patients were divided into the observation group(31 cases treated with tantalum cage combined with autograft bone) and control group(29 cases treated with autograft bone).The operation time, intraoperative blood loss, postoperative drainage and postoperative duration for bed rest in two groups were recorded.The visual analogue score(VAS), Oswestry dysfunction index(ODI), degree of spondylolisthesis, height of posterior margin of lumbar space and angle of lumbar lordosis in two groups were recorded throughout the treatment process. ResultsThere was no statistical significance in the height of posterior margin of intervertebral space between two groups before and immediately after surgery(P>0.05), but the differences of which between two groups after 3 and 12 months were statistically significant(P < 0.01).There was no statistical significance in the lumbar lordosis angle between two groups before and immediately after surgery(P>0.05), but the differences of which between two groups after 3 and 12 months were statistically significant(P < 0.01).The degree of lumbar spondylolisthesis, posterior margin height of intervertebral space and lumbar lordosis angle in two groups were significantly improved immediately after operation, 3 months after operation and 12 months after operation(P < 0.01).There was no statistical significance in the waist VAS score in two groups between postoperation, and before and immediately after surgery(P>0.05), but the differences of which in two groups between after 3 and 12 months were statistically significant(P < 0.01).There was no statistical significannce in the leg VAS score in two groups among before operation, immediately after surgery and after 3 and 12 months of operation(P>0.05).There was no statistical significance in the ODI in two groups among before operation, immediately after operation and after 3 and 12 months of operation(P>0.05).The waist VAS score, leg VAS score and ODI score in two groups immediately after surgery, after 3 months and 12 months of surgery were significantly better than those before operation(P < 0.01). ConclusionsThe PLIF combined with tantalum cage and autologous bone transplantation can maintain the lumbar lordosis angle and lumbar posterior margin height, and the long-term relief effects of lumbar pain of which is better than that of autologous bone transplantation alone. -
表 1 2组病人年龄、BMI、性别、手术节段比较
分组 n 年龄/岁 BMI/(kg/m2) 男 女 手术节段 L4~5 L5~S1 观察组 31 55.39±9.97 26.95±1.07 8 23 12 19 对照组 29 56.59±9.28 26.87±1.00 8 21 16 13 χ2 — 0.48△ 0.30△ 0.02 0.23 P — > 0.05 > 0.05 > 0.05 > 0.05 △示t值 表 2 2组手术时间、术中出血量、术后引流量、术后卧床时间比较(x±s)
分组 n 手术时间/min 术中出血量/mL 术后引流量/mL 术后卧床时间/d 观察组 31 108.65±5.31 152.77±20.32 161.90±15.75 6.00±0.775 对照组 29 110.48±4.04 150.76±16.60 167.69±16.42 6.10±0.673 t — 1.5 0.42 1.39 0.55 P — > 0.05 > 0.05 > 0.05 > 0.05 表 3 腰椎滑脱程度、椎间隙后缘高度、腰椎前凸角度比较(x±s)
分组 n 术前 术后即刻 术后3个月 术后12个月 F P MS 组内 腰椎滑脱程度/% 观察组 31 25.48±5.06 13.87±4.95* 14.84±5.08* 15.16±5.08* 36.29 < 0.01 25.430 对照组 29 26.21±4.94 13.79±4.94* 14.14±5.01* 14.48±5.06* 42.57 < 0.01 1 059.100 t — 0.56 0.06 0.54 0.52 — — — P — > 0.05 > 0.05 > 0.05 > 0.05 — — — 椎间隙后缘高度/mm 观察组 31 6.26±1.44 10.42±1.18* 10.48±1.00* 10.13±0.85* 100.18 < 0.01 1.297 对照组 29 6.41±1.76 10.45±1.06* 9.48±1.02*# 8.90±1.24*# 50.65 < 0.01 1.700 t — 0.38 0.10 3.84 4.54 — — — P — > 0.05 > 0.05 < 0.01 < 0.01 — — — 腰椎前凸角度/(°) 观察组 31 54.68±8.32 39.35±4.18* 40.32±3.76* 40.26±3.63* 59.00 < 0.01 28.502 对照组 29 55.31±8.41 40.86±3.91* 45.38±3.28*# 46.83±3.75*# 38.16 < 0.01 27.709 t — 0.29 1.44 5.53 6.89 — — — P — > 0.05 > 0.05 < 0.01 < 0.01 — — — q检验:与术前比较*P < 0.05;与术后即刻比较#P < 0.05 表 4 2组腰部、腿部VAS评分、ODI评分比较(x±s; 分)
分组 n 术前 术后即刻 术后3个月 术后12个月 F P MS 组内 腰部VAS评分 观察组 31 6.52±0.96 3.13±0.67* 1.90±0.87*# 1.65±0.49*# 262.27 < 0.01 0.592 对照组 29 6.69±1.04 2.86±0.69* 2.34±0.48*# 2.24±0.58*# 245.97 < 0.01 0.531 t — 0.67 1.52 2.41 4.34 — — — P — > 0.05 > 0.05 < 0.05 < 0.01 — — — 腿部VAS评分 观察组 31 7.65±0.49 3.61±0.62* 1.87±0.67*# 1.84±0.37*# 765.40 < 0.01 0.303 对照组 29 7.72±0.65 3.52±0.51* 1.97±0.68*# 1.83±0.83*# 477.95 < 0.01 0.458 t — 0.54 0.65 0.54 0.11 — — — P — > 0.05 > 0.05 > 0.05 > 0.05 — — — ODI评分 观察组 31 17.58±3.01 7.42±1.93* 3.90±2.39*# 3.42±1.98*# 239.46 < 0.01 5.604 对照组 29 18.59±2.56 8.10±1.70* 4.24±1.70*# 3.55±1.86*# 353.93 < 0.01 3.948 t — 1.39 1.46 0.63 0.27 — — — P — > 0.05 > 0.05 > 0.05 > 0.05 — — — q检验:与术前比较*P < 0.05;与术后即刻比较#P < 0.05 -
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