BacFuse棘突间植入术和后路椎间融合固定术治疗腰椎间盘突出症的对比研究

Treatment of single lumbar disc herniation with Bac Fuse interspinous implant and posterior lumbar interbody fusion:a comparative analysis

目的通过与后路椎间融合固定术(PLIF)对比,评价Bac Fuse棘突间植入术治疗腰椎间盘突出症的中短期临床疗效。方法回顾性分析2014年1月至2015年1月符合入组标准的单节段腰椎间盘突出症60例,其中BacFuse组30例,PLIF组30例。统计分析两组的住院时间、手术时间、术中失血量。术前、术后6月的视觉模拟评分(VAS)、日本骨科学会腰痛评分(JOA)、椎间盘后缘高度(PDH)。结果 BacFuse组性别、年龄、手术节段与PLIF组相比较无统计学差异。BacFuse组和PLIF组相比,住院时间较短(t=-10.17,P<0.001),手术时间也较短(t=-28.94,P<0.001),出血量较少(t=-31.03,P<0.001),差异均有统计学意义。术后6月随访两组VAS评分均小于术前(P<0.001),两组术前及术后6个月随访VAS评分差异无统计学意义。术后6月随访两组JOA评分均显著大于术前(P<0.001),两组术前及术后6个月随访JOA评分差异无统计学意义。BacFuse组术前PDH 6.26±1.7 mm,6个月随访8.27±1.9 mm,较术前明显改善(t=-12.347,P<0.001)。PLIF组术前PDH 6.33±1.4 mm,6个月随访8.41±1.4mm,较术前明显改善(t=-14.007,P<0.001)。两组术前及术后6月随访PDH差异无统计学意义(P>0.05)。结论 BacFuse棘突间植入术在与PLIF效果相似的情况下损伤更小,是治疗腰椎间盘突出症的有效微创方法。

Objective To evaluate the short- term clinical effect of Bac Fuse interspinous implant in the treatment of lumbar disc herniation by comparing with posterior lumbar interbody fusion（ PLIF）. Methods From January 2014 to January 2015,60 lumbar disc herniation patients who were accorded with the entry value were divided into two groups. 30 cases were treated with single Bac Fuse interspinous implant and 30 cases with PLIF. The hospital stay,operative time and blood loss were surveyed and compared between two groups. VAS scales,JOA scales and PDH at preoperative and six- months follow- up were evaluated and compared between two groups. Results There was no significant difference in sex,age and surgical procedure between the two groups. The hospital stay,operative time,and blood loss in the BacFuse group were significantly less than those in the PLIF group（ all P〈0. 001）. VAS scales of the six- months follow- up were significantly lower than preoperative in both groups（ P〈0. 001）; however,there were no significant differences neither at preoperative or follow- up between the two groups. JOA scales of the six- months follow- up were significantly higher than preoperative in both groups（ P〈0. 001）; however,there were no significant differences neither at preoperative or follow- up between the two groups. PDH of the Bac Fuse group was significantly improved at six- months follow- up（ 8. 27 ± 1. 9 mm） than preoperative（ 6. 26 ± 1. 7mm）（ t =- 12. 347,P〈0. 001）. PDH of the PLIF group was also significantly improved at six- months follow- up（ 8. 41 ± 1. 4 mm） than preoperative（ 6. 33 ± 1. 4 mm）（ t =- 14. 007,P〈0. 001）. There was no significant difference in PDH neither at preoperative or follow- up between two groups. Conclusion The effect of BacFuse and PLIF in the treatment of lumbar disc herniation was similar. BacFuse is an effective and minimally invasive technique.