改良单侧后路椎体间融合术治疗腰椎间盘突出合并椎管狭窄的疗效分析

Clinical Effect of Modified Unilateral Posterior Lumbar Interbody Fusion on Lumbar Disc Herniation Combined with Spinal Stenosis

目的探讨改良单侧后路椎体间融合术(PLIF)治疗腰椎间盘突出合并椎管狭窄的疗效。方法选取2013年1月—2014年8月苏北人民医院收治的腰椎间盘突出合并椎管狭窄患者158例,根据手术方式分为对照组(n=83)和观察组(n=75)。观察组患者行改良单侧PLIF,对照组患者行传统PLIF。比较两组患者的手术时间、术中出血量、术后住院时间,术前、术后1个月、术后1年的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分,以及术前、术后6个月的日本骨科协会评估治疗(JOA)评分。结果观察组患者的手术时间短于对照组,术中出血量低于对照组(P<0.05);两组患者术后住院时间比较,差异无统计学意义(P>0.05)。两组患者VAS评分、ODI评分比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);手术方法和时间在VAS评分、ODI评分上存在交互作用(P<0.05)。手术前、后两组患者JOA评分比较,差异均无统计学意义(P>0.05)。结论改良单侧PLIF治疗腰椎间盘突出合并椎管狭窄,具有创伤较小、出血少、疗效好、术后腰背痛发生率低的优点,值得临床推广应用。

Objective To explore the clinical effect of modified unilateral posterior lumbar interbody fusion （ PLIF ） on lumbar disc herniation combined with spinal stenosis. Methods A total of 158 lumbar disc herniation patients combined with spinal stenosis were selected in Subei People＇s Hospital form January 2013 to August 2014,and they were divided into control group （n = 83） and observation group （n 5） according to the operation mode. Patients of observation group were treated with modified unilateral PLIF , while patients of control group were treated with traditional PLIF . The operation time , intraoperative blood loss, postoperative hospital stay, the VAS score and ODI score before operation, 1 month and 1 year after the operat ion, and the JOA score before and 6 months after the operation were compared between the two groups. Results The operation time of the observation group was statistically significantly shorter than that of control group （P 〈0. 05）. The intraoperative blood loss of the observation group was statistically significa ntly lower than that of control group （ P 〈 0. 05 ）. No statistically significant differences of postoperative hospital stay was found between the two groups （P 〉 0. 05 ）. The VAS score and ODI score of the two groups were statistical ly significantly different （P 〈 0. 05） ; the difference was statistically significant in different time points （ P 〈 0. 05 ） ; there was interaction between groups and time points （P 〈 0. 05 ）. No statistically significant differences of JOA score was found between the two groups both before and 6 months after the operation （P 〉 0. 05 ）. Conclusion With the advantages of less trauma,less bleeding, better curative effect, and lower incidence of postoperative low back pain , modified unilateral PLIF of lumbar disc herniation merger stenosis would be worthy of clinical popularization and application.