保留后方韧带复合体后路腰椎融合术治疗峡部裂型腰椎滑脱症的临床疗效分析

Analysis of the Clinical Efficacy of Posterior Lumbar Fusion with Posterior Ligament-preserving Complex in the Treatment of Spondylolisthesis Type Lumbar Spondylolisthesis

目的探讨保留后方韧带复合体后路腰椎融合术治疗峡部裂型腰椎滑脱症的临床疗效。方法方便选取2016年1月—2018年8月该院收治的68例峡部裂型腰椎滑脱症,根据手术方式的不同,分为两组,35例采用保留后方韧带复合体后路腰椎融合术(观察组),33例采用传统的后路全椎板切除腰椎椎间融合术(对照组),比较两组的手术时间、手术出血量、疼痛视觉模拟评分(VAS)、Oswestry功能障碍评分(oswestry disability index,ODI)、邻近节段退变(ASD)指标。结果两组的手术时间、手术出血量差异无统计学意义(P>0.05);两组术前,术后3个月、6个月、12个月时,两组间的VAS评分、ODI评分差异无统计学意义(P>0.05);但在术后24个月时,观察组的VAS评分为(0.72±0.25)分,明显低于对照组的(1.11±0.28)分,差异有统计学意义(t=6.066,P<0.05);观察组的ODI评分为(17.09±4.69)分,明显低于对照组的(20.06±4.70)分,差异有统计学意义(t=2.607,P=0.011);观察组的1例出现ASD,占(2.86%),对照组8例出现ASD,占(24.24%),差异有统计学意义(χ^(2)=5.030,P=0.009)。结论保留后方韧带复合体后路腰椎椎间融合术,能够改善患者术后腰部疼痛症状,提高腰部术后功能,降低ASD的发生,临床疗效满意。

Objective To investigate the clinical effect of posterior lumbar fusion with preserving the posterior ligament complex in the treatment of spondylolisthesis.Methods From January 2016 the hospital 2018,a total of 68 cases of isthmic spondylolisthesis were convenient selected.According to different surgical methods,they were divided into two groups.35 cases underwent posterior lumbar fusion with preserving the posterior ligament complex(observation group),33 cases underwent traditional posterior laminectomy and lumbar interbody fusion(control group).The operation time,surgical blood loss,Pain visual analogue scale(VAS),oswestry disability index(ODI),and adjacent segment degeneration(ASD)indexes were compared between the two groups.Results There was no statistically significant difference in operation time and blood loss between the two groups(P>0.05);the difference in VAS score and ODI score between the two groups before operation,3 months,6 months,and 12 months after operation was not statistically significant(P>0.05);but at 24 months after surgery,the VAS score of the observation group was(0.72±0.25)points,which was significantly lower than that of the control group(1.11±0.28)points,and the difference was statistically significant(t=6.066,P<0.05);the ODI score of the observation group was(17.09±4.69)points,which was significantly lower than the(20.06±4.70)points of the control group,and the difference was statistically significant(t=2.607,P=0.011);the number of ASD cases in the observation group was 1 case,accounting for 2.86%,and 8 cases in the control group had ASD,accounting for 24.24%.The difference was statistically significant(χ^(2)=5.030,P=0.009).Conclusion The posterior lumbar interbody fusion with the posterior ligament complex can be improved after surgery.Symptoms of lumbar pain,improve lumbar postoperative function,reduce the occurrence of ASD,and have satisfactory clinical effects.