经椎间孔腰椎间融合术治疗腰椎融合术后邻近节段病变的中长期疗效及并发症分析

The middle-long term efficacy and complications analysis of transforaminal lumbar interbody fusion in the treatment of adjacent segment disease after lumbar fusion

目的探讨经椎间孔腰椎间融合术(TLIF)治疗腰椎融合术后邻近节段病变的中长期疗效及并发症发生情况。方法采用TLIF治疗30例腰椎融合术后邻近节段病变患者。分析术后并发症发生情况。术后1周、末次随访时采用腰痛及下肢痛VAS评分、腰椎JOA评分评定临床症状改善情况。结果患者均获得随访,时间4.3~9.0(6.0±1.9)年。下肢痛VAS评分、腰椎JOA评分:术后1周、末次随访时较术前明显改善(P<0.05);末次随访时与术后1周比较差异均无统计学意义(P>0.05)。腰痛VAS评分:术后1周较术前明显改善(P<0.05);末次随访时与术前比较差异无统计学意义(P>0.05)。术后15例(50%)出现18例次并发症:肺部感染1例次,切口愈合不良1例次,切口深部感染1例次,残留一侧下肢神经疼痛2例次,融合椎板骨折1例次,远隔椎体骨折1例次,腰骶部反复疼痛2例次,再次出现相邻节段病变(包括相邻椎体骨折和近端交界性后凸)9例次。结论采用TLIF治疗腰椎融合术后邻近节段病变疗效满意,但随着随访时间的延长,临床疗效逐渐下降,且继发邻近节段病变的风险高。

Objective To investigate the middle-long term efficacy and complications incidence situation of transforaminal lumbar interbody fusion(TLIF)in the treatment of postoperative adjacent segment disease(ASD)after lumbar fusion.Methods The 30 patients who suffered from ASD after lumbar fusion surgery were treated by TLIF revision.The incidence situation of postoperative complications was analyzed.At postoperative 1 week and the last follow-up,the pain VAS of waist and lower limb,lumbar JOA score were used to evaluate the improvement status of clinical symptoms.Results All patients were followed up for 4.3~9.0(6.0±1.9)years.VAS of lower limb and JOA score of lumbar spine:at postoperative 1 week and the last follow-up,they were significantly improved than the preoperation(P<0.05);there was no difference between the postoperative 1 week and the last follow-up(P>0.05).VAS of waist pain:which was significantly improved at postoperative 1 week,compared with that before operation(P<0.05);there was no significant difference between preoperation and the last follow-up(P>0.05).There were 18 case-times complications in 15 cases(50%)after operation:1 case-times of pulmonary infection,1 case-times of wound dehiscence,1 case-times of deep incision infection,2 case-times of residual lower extremity neurological symptoms,1 case-times of spontaneous fracture of the laminar fusion,1 case-times of distal partition vertebral body fracture,2 case-times of recurrent pain in lumbosacral region and 9 case-times of ASD recurrence(including adjacent vertebral fracture and proximal junctional kyphosis).Conclusions The use of TLIF for treatment of ASD after lumbar spine fusion can achieve satisfactory clinical results,while with the extension of follow-up time,the clinical efficacy decreases gradually,and the secondary ASD risk is high.