保留后方韧带复合体在腰椎后路全椎板减压改良TLIF手术中的疗效观察

Efficacy of preservation of posterior ligament complex in improved transforaminal lumbar interbody fusion

目的探讨在腰椎后路全椎板减压改良经椎间孔椎体间融合(TLIF)手术时,保留后方韧带复合体(PLC)对手术疗效的影响。方法随机选取2014年2月至2016年2月收治的60例腰椎退变性椎管狭窄、腰椎间盘突出伴不稳患者,分为研究组和对照组各30例,其中对照组切除PLC行改良TLIF术,研究组保留PLC(切除黄韧带)行改良TLIF术,比较两组的手术时间、出血量、住院时间、JOA评分和改善率以及慢性疼痛、僵硬不适、椎间融合和临近节段退变(ASD)的例数。结果研究组的手术时间、出血量和住院时间均小于对照组,差异有统计学意义(P<0.05);两组的术前、术后3个月JOA评分及改善率比较,差异无显著性(P>0.05),但是术后3个月的JOA评分较术前均明显改善,差异有显著性(P<0.05);术后1年研究组慢性疼痛、僵硬不适和ASD例数均少于对照组,差异有显著性(P<0.05);对照组1例椎间未融合,研究组全部融合,两组椎间融合率无差异(P>0.05)。两组手术顺利,无1例感染。结论保留PLC全椎板减压改良TLIF术,手术时间短、出血量少,远期并发症和ASD发生率明显降低,临床疗效显著。

Objective To investigate the efficacy of preservation of posterior ligament complex(PLC)in the operation of the transforaminal lumbar interbody fusion(TLIF).Method Sixty patients of lumbar degenerative cervical stenosis and lumbar disc herniation complicated with lumbar instability from February 2014 to February 2016 were divided into observation group and control group.The control group performed resection of PLC by improved TLIF and the observation group preserved PLC(removal of yellow ligament)by modified TLIF technique.The operation time,blood loss,hospital stay,JOA score and improvement rate,and chronic pain,stiffness,inter-vertebral fusion and cases of adjacent segment degeneration(ASD)in the 2 groups were compared.Results There were shorter operation time,less blood loss and shorter hospital stay in the observation group when compared with those in the control group,and the difference was statistically significant(P<0.05).There was no significant dif-ference regarding to JOA score and improvement rate between the two groups before and 3 months after the surgery(P>0.05),but the JOA score 3 months after the surgery was significantly improved and it was statistically significant(P<0.05).One year after the surgery,less chronic pain,stiffness and ASD cases were found in the observation group,which was statistically significant(P<0.05).There was 1 case without fusion in the control group but no in the observation group and the fusion rate of the two groups showed no statistical significance(P>0.05).No case of infection was found in the 2 groups.Conclusion With shorter operation time,less blood loss and longterm complications and low incidence of ASD,modified TLIF with the preservation of PLC has good clinical effect.