模塑形脊柱矫形器在后路腰椎椎间融合术后的早期应用

Early application of moulded spinal orthosis after posterior lumbar interbody fusion

目的探讨模塑形脊柱矫形器在后路腰椎椎间融合术后早期应用的疗效。方法将纳入的66例后路腰椎椎间融合术后患者随机分为治疗组和对照组,各33例。治疗组术后48～72﹙53.6±7.9﹚小时佩戴模塑形脊柱矫形器治疗;对照组术后4～5﹙4.3±0.7﹚周佩戴腰围治疗。观察2组内固定的稳定性、并发症发生情况、术后卧床时间、住院时间及出院满意度。结果治疗组术后佩戴模塑形脊柱矫形器时间3～5﹙3.9±1.2﹚个月,随访12～39﹙20.8±5.7﹚个月;未见内固定松动、移位等并发症的发生;术后1～2﹙1.4±0.5﹚周可正常平地行走;住院时间1～2﹙1.3±0.4﹚周。对照组术后佩戴腰围时间3～5﹙4.2±1.3﹚个月,随访12～38﹙20.5±4.3﹚个月;椎弓根钉断裂及融合器移位3例,肺部感染3例,泌尿系感染2例,深静脉血栓3例,褥疮2例;术后4～6﹙5.1±1.2﹚周可正常平地行走;住院时间2～3﹙2.4±0.5﹚周。2组患者出院满意度分别为90～100﹙95.7±8.9﹚%、60～80﹙71.8±9.7﹚%,治疗组满意度优于对照组﹙<0.05﹚。结论后路腰椎椎间融合术后早期行模塑型脊柱矫形器治疗的患者,可72小时内下地行走,缩短卧床时间及住院时间,加强术后腰椎的稳定性,减少并发症的发生,明显提高了患者的满意度。

Objective To explore the therapeutic effect of early using moulded spinal orthosis after posterior lumbar interbody fusion（PLIF）.Method 66 cases after PLIF were randomly divided into treatment and control groups,33 cases respectively.The treatment group wore moulded spinal orthosis in 48～72h（average 53.6±7.9h）after PLIF;the control group wore Waist Support in 4～5w（average 4.3±0.7w）.We observed the internal fixation stability、complication、post-operative bed time、the duration of hospitalization and the patients’satisfaction when leaving hospital between the two groups.Results The treatment group wore moulded spinal orthsis for 3～5 months,followed 12～39 months,no looseness、 breakage and migration of the internal fixation were found,and no pulmonary infection、urinary infection、deep venous thrombosis、bedsore occurred;the patients could stand in 48～72h and walk normally in 1～2w after PLIF;the duration of hospitalization was 1～2w.The control group wore Waist Support for 3～5 months,followed 12～38 months;there were 3 patients who had got their implants broken and migrated,after revision surgery they wore moulded spinal orthsis,and recovered very well;3 cases encountered pulmonary infection,2 cases occurred urinary infection,3 cases had deep venous thrombosis and 2 cases complicated bedsore;the patients could stand in 4～5w and walk normally in 4～6w after PLIF;the duration of hospitalization was 2～3w.The patients’satisfaction of the 2 groups respectively was 90～100（95.7±8.9）%、 60～80（71.8±9.7）%,and the satisfaction of the treatment group was better than the control group’ s（P〈 0.05）.Conclusion The patients early using moulded spinal orthosis can stand in 72h after PLIF;compared with Waist Support,it shortens rest time and the duration of hospitalization of patients,strengthens lumbar spinal stability,avoids complications,and obviously improves the patients’satisfaction.