融合结合非融合技术治疗腰椎退行性疾病的临床疗效分析

Analysis on clinical efficacy of fusion combined with non-fusion technology in treating lumbar degenerative disease

目的探讨融合结合非融合技术治疗腰椎退行性疾病的中期疗效及对相邻节段退变的影响。方法回顾性研究60例腰椎退行性疾病患者的临床资料,30例采用病变责任节段融合结合邻近退变节段动态固定术(观察组),30例采用单纯融合术(对照组),比较两组手术指标,包括手术时间、术中出血量、术后引流量、拔管时间、下地活动时间、住院时间。两组均分别于术前、术后3个月、末次随访时采用疼痛视觉模拟(VAS)评分、Oewestry功能障碍指数(ODI)评分、腰椎神经功能(JOA)评分以及健康调查简表(SF-36)。于术前及末次随访时,行X线、CT及MRI检查,椎间盘分级根据腰椎MRI矢状位T2相参照Pfirrmann分级法评定,关节突关节退变利用CT进行判断。结果两组患者手术时间、术中出血量、术后引流量、拔管时间、下地活动时间、住院时间差异无统计学意义(P>0.05)。两组术后3个月、末次随访VAS评分、ODI评分、JOA评分、SF-36量表得分均较术前显著升高,差异有统计学意义(P<0.05),两组之间术前、术后3个月、末次随访VAS评分、ODI评分、JOA评分、SF-36量表得分差异无统计学意义(P>0.05)。末次随访时观察组Pfirrmann分级升高3例(10.0%),明显低于对照组的11例(36.7%),差异有统计学意义(P<0.05);观察组关节突关节退变2例(6.7%),显著低于对照组的10例(33.3%),差异有统计学意义(P<0.05)。结论融合结合非融合技术联合应用治疗腰椎退行性疾病,在充分减压的同时有效缓解了临近节段的退变。

Objective To investigate the medium-term effect of fusion combined with non-fusion technology in the treatment of lumbar degenerative disease and its influence on adjacent segment degeneration. Methods The clinical data in 60 cases of lumbar degenerative disease were retrospectively studied. Thirty cases were treated with the responsibility segment fusion and adjacent de- generation segment dynamic fixation（observation group）,and other 30 cases adopted simple fusion（control group）. The operation indexes were compared between the two groups,including the operation time,intraoperative blood loss, postoperative drainage vol- ume, extubation time, time of off-bed and hospital stay. The visual analog pain（VAS） score, Oewestry disability index（ODD score, lumbar nerve function score（JOA） and short form health survey（SF-36） before operation, postoperative 3 months and at the last follow-up were evaluated in the two groups. X-ray,CT and MRI examination were performed before operation and at the last follow- up. The intervertebral disc grading was performed according to the lumbar sagittal MRI T2 imaging and referring to the Pfirrmann grading. The articular process joint degeneration was judged by CT. Results The operation time,intraoperative lood loss,postoperative drainage volume,extubation time,time of off-bed and hospital stay had no statistically significant differences between the two groups（P〉0.05）. The VAS score,ODI score,JOA score and SF-36 score at postoperative 3 months and last follow-up in the two groups were significantly increased compared with before operation, the difference was statistically significant（P〈0.05）, but which had no statistically significant differences between two groups（P〉0.05）. At last follow-up,the Pfirrmann grade in the observation group was increased in 3 cases（10.0%）, which were significantly lower than 11 cases（36.7 % ） in the control group, the difference was statistically significant（P〈0.05） ; the articular process joint degeneration had 2 cases（6.7G ） in the observation group,which were significantly lower than 10 cases（33.3%） in the control group, the difference was statistically significant（P〈0.05）. Conclusion Fusion combined with non-fusion technology in the treatment of lumbar degenerative disease can fully decompress, meanwhile effectively alleviate the degeneration of adjacent segments.