经椎间孔入路腰椎后路融合术对腰椎间盘突出症患者疼痛、腰椎功能和生活质量的影响

Effect of transforaminal posterior lumbar interbody fusion on pain,lumbar function and quality of life in patients with lumbar disc herniation

目的探讨经椎间孔入路腰椎后路融合术对腰椎间盘突出症(LDH)患者疼痛、腰椎功能和生活质量的影响。方法选择永康市第一人民医院于2015年5月至2019年5月收治的LDH患者120例为研究对象。患者均行经椎间孔入路腰椎后路融合术治疗。记录并发症发生情况和随访优良率。术前、术后6个月和术后12个月腰痛/下肢痛视觉模拟评分法(VAS)、腰椎JOA评分、Oswestry功能障碍指数(ODI)评分及生活质量评分变化。结果术后12个月,发生健侧神经损伤3例,发生率为2.50%;其中优占32.50%(39/120),良占53.33%(64/120),可占10.83%(13/120),差占3.33%(4/120),优良率为85.83%(103/120)。术后6个月VAS评分[(4.53±0.76)分]和术后12个月VAS评分[(2.64±0.57)分]均低于术前[(7.38±1.02)分](t=24.544、44.438,均P<0.05);且术后12个月低于术后6个月(t=21.794,P<0.05)。术后6个月腰椎JOA评分[(13.52±2.36)分]和术后12个月腰椎JOA评分[(21.79±3.64)分]均高于术前[(7.38±1.02)分](t=22.956、39.029,均P<0.05);且术后12个月高于术后6个月(t=20.883,P<0.05)。术后6个月ODI评分[(15.27±3.71)分]和术后12个月ODI评分[(9.09±1.85)分]均低于术前[(35.42±5.46)分](t=33.438、50.032,均P<0.05);且术后12个月低于术后6个月(t=16.330,P<0.05)。术后6个月世界卫生组织(WHO)生存质量测定量表简表(QOL-BEFF)量表评分[(59.83±7.51)分]和术后12个月QOL-BEFF量表评分[(67.12±6.39)分]均高于术前[(35.42±5.46)分](t=18.464、29.898,均P<0.05);且术后12个月高于术后6个月(t=8.099,P<0.05)。结论经椎间孔入路腰椎后路融合术对LDH患者疗效良好,术后并发症少,可明显减轻患者疼痛,改善患者腰椎功能和生活质量。

Objective To investigate the effect of transforaminal posterior lumbar interbody fusion on pain,lumbar function and quality of life in patients with lumbar disc herniation.Methods A total of 120 patients with lumbar disc herniation who received treatment in the First People's Hospital of Yongkang from May 2015 to May 2019 were included in this study.All these patients underwent posterior lumbar interbody fusion via the transforaminal approach.The incidence of complications and the excellent and good rate of therapeutic effects were recorded.Visual Analogue Scale score,Japanese Orthopedic Association score,Oswestry disability index,and quality of life before and 6 and 12 months after surgery were recorded.Results At 12 months after surgery,contralateral nerve injury occurred in 3(2.50%)cases.Therapeutic effect was rated excellent in 32.50%(39/120)cases,good in 53.33%(64/120)cases,fair in 10.83%(13/120)cases,and poor in 3.33%(4/120)cases,with an excellent and good rate of 85.83%(103/120).The Visual Analogue Scale score at 6 months[(4.53±0.76)points]and 12 months after surgery[(2.64±0.57)points]was significantly lower than that before surgery[(7.38±1.02)points](t=24.544,44.438,both P<0.05).The Visual Analogue Scale score at 12 months after surgery was significantly lower than that at 6 months after surgery(t=21.794,P<0.05).The Japanese Orthopedic Association score at 6 months[(13.52±2.36)points]and 12 months after surgery[(21.79±3.64)points]was significantly higher than that before surgery[(7.38±1.02)points](t=22.956,39.029,both P<0.05).The Japanese Orthopedic Association score at 12 months after surgery was significantly higher than that at 6 months after surgery(t=20.883,P<0.05).The Oswestry disability index at 6 months[(15.27±3.71)points]and 12 months after surery[(9.09±1.85)points]was significantly lower than that before surgery[(35.42±5.46)points](t=33.438,50.032,both P<0.05).The Oswestry disability index at 12 months after surgery was significantly lower than that at 6 months after surgery(t=16.330,P<0.05).The score of the World Health Organization Quality of Life Scale brief version at 6 months[(59.83±7.51)points]and 12 months after surgery[(67.12±6.39)points]was significantly higher than that before surgery[(35.42±5.46)points](t=18.464,29.898,both P<0.05).The score of the World Health Organization Quality of Life Scale brief version at 12 months after surgery was significantly higher than that at 6 months after surgery(t=8.099,P<0.05).Conclusion Transforaminal posterior lumbar interbody fusion has good curative effect on lumbar disc herniation with less postoperative complications.It can obviously alleviate pain and improve patient's lumbar function and quality of life.