两种不同术式治疗腰椎融合术后邻近节段退变的疗效

The Curative Effect of Two Different Surgical Procedures on Adjacent Segment DegenerationAfter Lumbar Fusion

目的比较极外侧入路腰椎椎间融合术(XLIF)与传统后路手术治疗腰椎融合术后邻近节段退变的临床效果。方法选择2014年1月~2017年10月我院收治的腰椎融合术后邻近节段病变患者40例,随机分为A、B两组,各20例。A组采用极外侧入路腰椎椎间植骨椎体钉固定治疗,B组采用传统后侧入路椎间植骨椎弓根钉固定治疗;记录两组手术切口长度、手术时间、术中出血量、术后引流液量、住院时间,比较两组手术前、后Oswestry功能障碍指数(ODI)、疼痛评分(VAS)、椎间融合率及术后并发症。结果A组手术切口长度、手术时间、术中出血量、术后引流量、住院时间均少于B组,差异有统计学意义(P<0.05);两组术后1、6、12个月ODI指数、VAS均优于术前,差异有统计学意义(P<0.05);两组术后1个月ODI指数、VAS评分比较,差异有统计学意义(P<0.05);两组术后6、12个月ODI指数、VAS评分间比较,差异无统计学意义(P>0.05);术后12个月两组椎间融合率均为95.00%;A组术后股神经损伤2例,术后9周内恢复;B组脑脊液漏3例,切口浅表感染1例予抗感染治愈。结论与传统后路手术相比,极外侧入路治疗腰椎融合术后邻近节段病变效果较好,具有手术损伤小、时间短、并发症少、脊柱稳定性好、术后恢复快及效果理想等优点。

Objective To compare the clinical effects of extreme lateral lumbar interbody fusion(XLIF)and traditional posterior approach in the treatment of adjacent segment degeneration after lumbar fusion.Methods From January 2014 to October 2017,40 patients with adjacent segment lesions after lumbar fusion were selected and randomly divided into two groups A and B,with 20 cases in each group.Group A was treated with extreme lateral approach lumbar intervertebral bone graft and pedicle screw fixation,group B was treated with traditional posterior approach intervertebral bone graft and pedicle screw fixation;the length of the surgical incision,operation time,and intraoperative bleeding were recorded the Oswestry dysfunction index(ODI),pain score(VAS),intervertebral fusion rate and postoperative complications were compared between the two groups before and after surgery.Results The length of surgical incision,operation time,intraoperative blood loss,postoperative drainage,and hospital stay in group A were less than those in group B,the difference was statistically significant(P<0.05);the two groups had ODI at 1,6,and 12 months after operation the index and VAS were better than those before operation,the difference was statistically significant(P<0.05);the comparison of ODI index and VAS score between the two groups at 1 month after operation was statistically significant(P<0.05);There was no significant difference in ODI index and VAS score between the two groups at 6 and 12 months after operation(P>0.05);the intervertebral fusion rate of both groups was 95.00%at 12 months after operation;group A after the femoral nerve 2 cases of injury recovered within 9 weeks after operation;3 cases of cerebrospinal fluid leakage in group B and 1 case of superficial infection of the incision were cured with anti-infection.Conclusion Compared with the traditional posterior approach,the extreme lateral approach had a better effect on the treatment of adjacent segment lesions after lumbar fusion,with less surgical damage,short time,fewer complications,good spinal stability,quick postoperative recovery and ideal results advantage.