固定CAGE和可扩张CAGE用于经侧方入路腰椎融合术的疗效对比

Evaluation of the curative effect of lumbar fusion through lateral approach with fixed CAGE and expandable CAGE

目的比较经侧方入路腰椎融合术中固定CAGE和可扩张CAGE的临床疗效。方法选取2015年1月—2018年12月在贵州中医药大学第二附属医院进行经侧方入路腰椎融合术的57例患者的临床资料进行回顾性研究,其中27例采用可扩张CAGE进行融合(观察组),30例使用固定CAGE进行融合(对照组)。记录两组患者术中出血量、手术相关并发症发生情况。术后拍摄X线片明确腰椎融合情况和CAGE沉降情况。采用视觉模拟评分(visual analogue scale,VAS)和腰椎奥斯维特功能障碍指数评分(ODI)对两组患者进行评价。结果两组患者均顺利完成手术,所有患者术后均完成随访,随访时间12~16个月,平均(13.16±2.42)个月。两组患者术前、术后6周、术后3个月、术后6个月的VAS评分和ODI评分差异无统计学意义(P>0.05);两组患者的术中出血量、术后恢复工作的时间差异亦无统计学意义(P>0.05);两组患者术后12个月的椎间隙高度和ODI评分差异有统计学意义(P<0.05),观察组患者高度和评分较对照组好;对照组发生CAGE沉降的概率大于观察组,差异有统计学意义(P<0.05)。两组患者术后并发症发生情况无明显差异。结论采用可扩张的CAGE进行经侧方入路腰椎融合术,在术后具有更好的椎间隙高度和功能评分。

Objective To compare the clinical effects of fixed CAGE and expandable CAGE in lumbar fusion through lateral approach.Methods The clinical data of patients who underwent lateral lumbar fusion in the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from January 2015 to December 2018 were retrospectively studied.Twenty seven patients were treated with expandable CAGE(observation group)and 30 patients with fixed CAGE(control group).The amount of intraoperative blood loss and the occurrence of operation-related complications were recorded in the two groups.X-ray films were taken after operation to determine the lumbar fusion and CAGE settlement.Visual analogue scale(VAS)and Oswestry Disability Index(ODI)were used to evaluate the two groups.Results The operation was completed successfully in both groups,and all patients were followed up after operation.The follow-up time was 12 to 16 months,with an average of(13.16±2.42)months.There was no significant difference in VAS score and ODI score before operation,6 weeks,3 months and 6 months after operation between the two groups(P>0.05).There was no significant difference in intraoperative blood loss and time to return to work between the two groups(P>0.05).There was significant difference in intervertebral space height and ODI score between the two groups 12 months after operation,and the height and score of the observation group were better than those of the control group.The probability of CAGE settlement in the control group was higher than that in the observation group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups.Conclusion The use of expandable CAGE for lateral lumbar fusion can achieve better intervertebral space height and functional score after operation.