| 王红辉,王腾飞,张学登.微创和传统开放后路腰椎椎间融合术治疗腰椎退行性疾病的远期预后[J].脊柱外科杂志,2022,20(4):235-241. |
微创和传统开放后路腰椎椎间融合术治疗腰椎退行性疾病的远期预后  点此下载全文 (Fulltext) |
| 王红辉 王腾飞 张学登 |
| 南阳医专第一附属医院骨二科, 南阳 473000 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2022.04.004 |
| 摘要点击次数: 296 |
| 全文下载次数: 175 |
| 摘要： |
| 目的探讨微创后路腰椎椎间融合术(MIS-PLIF)和传统开放PLIF对腰椎退行性疾病(LDD)远期疗效及安全性的影响。方法 2011年1月-2014年12月收治LDD患者182例,其中96例采用传统开放PLIF治疗(PLIF组),86例采用MIS-PLIF治疗(MIS-PLIF组)。比较2组腰椎矢状位参数、多裂肌横截面积及萎缩率、融合率、疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)及术后并发症发生情况,分析多裂肌萎缩率与顽固性腰背痛的相关性。结果 2组术后各随访时间点椎间隙高度恢复值和节段性前凸角恢复值差异均无统计学意义(P > 0.05)。2组术后1年腰椎前凸角恢复值差异无统计学意义(P > 0.05);但术后5年和末次随访时,MIS-PLIF组腰椎前凸角恢复值显著高于PLIF组,差异均有统计学意义(P < 0.05)。MIS-PLIF组术后各随访时间点多裂肌横截面积大于PLIF组,多裂肌萎缩率低于PLIF组,差异均有统计学意义(P < 0.05)。2组术后随访6个月融合率差异无统计学意义(P > 0.05)。2组术后各随访时间点下肢痛VAS评分差异无统计学意义(P > 0.05);MIS-PLIF组术后各随访时间点腰痛VAS评分、JOA评分及ODI均优于PLIF组,差异有统计学意义(P < 0.05)。MIS-PLIF组顽固性腰背痛发生率显著低于PLIF组,差异有统计学意义(P < 0.05)。合并顽固性腰背痛患者多裂肌萎缩率高于未合并顽固性腰背痛的患者,差异有统计学意义(P < 0.05)。结论术后多裂肌萎缩可能是导致顽固性腰背痛的重要原因,相较于传统开放PLIF,MIS-PLIF治疗LDD能够更有效地保持腰椎生理曲度,改善肢体活动功能,降低多裂肌萎缩程度,有助于避免顽固性腰背痛的发生。 |
| 关键词：腰椎 椎管狭窄 椎间盘移位 脊椎滑脱 脊柱融合术 外科手术,微创性 |
| Long-term prognosis of minimally invasive and traditional posterior lumbar interbody fusion in treatment of lumbar degenerative diseases Fulltext |
| Wang Honghui Wang Tengfei Zhang Xuedeng |
| Second Department of Orthopaedics, First Affiliated Hospital of Nanyang Medical College, Nanyang 473000, Henan, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the long-term efficacy and safety of minimally invasive posterior lumbar interbody fusion (MIS-PLIF) and traditional open PLIF for lumbar degenerative disease (LDD).Methods From January 2011 to December 2014,182 patients with LDD were treated,including 96 cases treated with traditional open PLIF (PLIF group) and 86 with MIS-PLIF (MIS-PLIF group).The lumbar sagittal parameters,cross-sectional area and atrophy rate of multifidus muscle,fusion rate,pain visual analogue scale (VAS) score,Japanese Orthopaedic Association (JOA) score,Oswestry disability index (ODI) and postoperative complications were compared between the 2 groups,and the correlation between atrophy rate of multifidus muscle and intractable low back pain was analyzed.Results There was no significant difference in the recovery of intervertebral space height and segmental lordosis between the 2 groups at each follow-up time point (P > 0.05).There was no significant difference in the recovery of lumbar lordosis between the 2 groups at postoperative 1 year (P > 0.05);however,at postoperative 5 years and the final follow-up,the recovery value of lumbar lordosis was significantly higher in MIS-PLIF group than in PLIF group,all with a statistical significance (P < 0.05).At each follow-up time point,the cross-sectional area of the multifidus muscle was greater in MIS-PLIF group than in PLIF group,and the atrophy rate of the multifidus muscle was in MIS-PLIF group lower than in PLIF group,all with a statistical significance (P < 0.05).There was no significant difference in fusion rate between the 2 groups at postoperative 6 months (P > 0.05).There was no significant difference in VAS score of leg pain between the 2 groups at each follow-up time point (P > 0.05);and at each follow-up time point,in the VAS score of low back pain,JOA score and ODI,MIS-PLIF group superior to PLIF group,all with a statistical significance (P < 0.05).The incidence of intractable low back pain in MIS-PLIF group was significantly lower than that in PLIF group,and the difference was statistically significant (P < 0.05).The atrophy rate of the multifidus muscle in the patients with intractable low back pain was significantly higher than that who without intractable low back pain,and the difference was statistically significant (P < 0.05).Conclusions Postoperative multifidus atrophy may be an important cause of intractable low back pain.Compared with traditional open PLIF,MIS-PLIF in the treatment of LDD can more effectively maintain lumbar physiological curvature,improve limb activity function,reduce the severity of multifidus atrophy,and help to avoid the occurrence of intractable low back pain. |
| Keywords:Lumbar vertebrae Spinal stenosis Intervertebral disc displacement Spondylolysis Spinal fusion Surgical procedures,minimally invasive |
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