中国修复重建外科杂志

中国修复重建外科杂志

保留后方韧带复合体的腰椎融合术远期疗效观察

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目的 对比是否保留后方韧带复合体(posterior ligamentous complex,PLC)的椎板开窗减压与全椎板切除减压腰椎融合术的远期临床疗效。 方法 回顾分析 2000 年 1 月—2005 年 1 月收治的下腰椎单节段退变性疾病行腰椎融合术并随访 10 年以上的 89 例患者临床资料。根据手术方式不同分为 2 组,A 组 33 例采用椎板开窗减压、椎间融合内固定术,B 组 56 例采用全椎板切除减压、内固定融合术。两组患者性别、年龄、体质量指数、病变类型、病程、病变节段及术前日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)、腰椎前凸 Cobb 角等一般资料比较差异无统计学意义(P>0.05),具有可比性。术后采用 JOA 下腰痛 29 分评分标准评价临床疗效,采用 VAS 评分评价疼痛改善情况,并记录末次随访时相邻节段退变(adjacent segment degeneration,ASD)发生情况。 结果 两组患者均获随访,随访时间 10~17 年,平均 12.6 年。A 组 3 例(9.1%)、B 组 5 例(8.9%)出现脑脊液漏,发生率比较差异无统计学意义(χ2=0.001,P=0.979)。两组均无感染、神经根损伤及内固定物松动、移位等并发症发生。两组均获得椎间融合,A、B 组融合时间分别为(3.4±1.2)、(3.7±1.6)个月,比较差异无统计学意义(t=0.420,P=0.676)。末次随访时两组 JOA 评分、VAS 评分较术前显著改善(P<0.05);A 组手术前后腰椎前凸 Cobb 角比较差异无统计学意义(t=0.293,P=0.772),B 组末次随访时腰椎前凸 Cobb 角较术前显著丢失(t=14.920,P=0.000)。末次随访时 A 组 VAS 评分及腰椎前凸 Cobb 角均优于 B 组(P<0.05);两组 JOA 评分比较差异无统计学意义(t=0.217,P=0.828)。A、B 组分别有 3 例(9.1%)和 21 例(37.5%)出现 ASD,比较差异有统计学意义(χ2=8.509,P=0.004)。 结论 两组均有满意的远期临床疗效,但在维持腰椎前凸和减少 ASD 发生率方面,保留 PLC 的腰椎融合术优于切除 PLC 的全椎板切除腰椎融合术。

Objective To compare the long-term effectiveness of wheather posterior ligamentous complex (PLC) preserved between posterior fenestration decompression interbody fusion and posterior total laminectomy interbody fusion. Methods The clinical data of 89 patients who suffered from single segmental degenerative diseases of lower lumbar spine and followed up more than 10 years after receiving lumbar spinal fusion between January 2000 and January 2005 were retrospectively analysed. The patients were divided into two groups according to the different surgical methods, the 33 patients in group A were treated with posterior lumbar fenestration decompression, interbody fusion, and internal fixation, while 56 patients in group B were treated with posterior total laminectomy resection decompression, interbody fusion, and internal fixation. There was no significant difference in gender, age, body mass index, type of lesion, disease duration, lesion segment, and preoperative Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) score, and Cobb angle of lumbar lordosis between the two groups (P>0.05). The effectiveness was evaluated by JOA score, and the improvement of pain was evaluated by VAS score. The incidence of adjacent segment degeneration (ASD) at last follow-up was recorded. Results Both groups were followed up 10-17 years (mean, 12.6 years). There were 3 cases (9.1%) in group A and 5 cases (8.9%) in group B complicated with cerebrospinal fluid leakage, showing no significant difference (χ2=0.001, P=0.979). There was no complication such as infection, nerve root injury, internal plant loosening or transposition in both groups. Intervertebral fusion was satisfactory in both groups. The fusion time in groups A and B was (3.4±1.2) months and (3.7±1.6) months respectively, and there was no significant difference between the two groups (t=0.420, P=0.676). At last follow-up, the JOA score and VAS score of the two groups were significantly improved when compared with preoperative ones (P<0.05); there was no significant difference in Cobb angle of lumbar lordosis before and after operation in group A (t=0.293, P=0.772), but the Cobb angle of lumbar lordosis in group B was significantly lost at last follow-up (t=14.920, P=0.000). At last follow-up, the VAS score and Cobb angle of lumbar lordosis in group A were significantly superior to those in group B (P<0.05); there was no significant difference in JOA score between the two groups (t=0.217, P=0.828). There were 3 cases (9.1%) in group A and 21 cases (37.5%) in group B complicated with ASD, showing significant difference between the two groups (χ2=8.509, P=0.004). Conclusion Long-term effectiveness of both groups was satisfactory, but in terms of maintaining lumbar lordosis and reducing the incidence of ASD, the lumbar fusion retaining PLC is superior to total laminectomy and lumbar fusion removing PLC.

关键词: 后方韧带复合体; 腰椎融合术; 相邻节段退变; 腰椎前凸角

Key words: Posterior ligamentous complex; lumbar interbody fusion; adjacent segment degeneration; lumbar lordosis angle

引用本文: 李玉伟, 王海蛟, 崔巍, 周鹏, 李程, 效伟, 胡冰涛, 李凡. 保留后方韧带复合体的腰椎融合术远期疗效观察. 中国修复重建外科杂志, 2019, 33(1): 56-60. doi: 10.7507/1002-1892.201809073 复制

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