腰椎侧前方入路手术治疗退行性腰椎滑脱的效果

Curative effect of lateral anterior approach on degenerative lumbar spondylolisthesis

目的探讨腰椎侧前方入路手术治疗退行性腰椎滑脱患者对脊柱功能、脊柱-骨盆矢状面参数的影响。方法选取2016年3月至2019年8月济宁医学院附属医院兖州院区收治的70例退行性腰椎滑脱患者为研究对象,根据手术方式分为对照组(35例)和观察组(37例),对照组采用腰椎滑脱复位手术,观察组采用腰椎侧前方入路手术。观察两组手术时间、术中出血量及术后引流量,术后3个月脊柱功能(巴氏功能活动指数和巴氏病情活动指数)、脊柱-骨盆矢状面参数[腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、脊柱矢状面平衡(SVA)]、腰痛与下肢痛疼痛视觉模拟评分(VAS)、腰椎0swestry功能障碍指数(ODI)。结果观察组患者手术时间、术中出血量及术后引流量明显低于对照组,差异有统计学意义(P<0.05)。术前,两组患者巴氏功能活动指数、巴氏病情活动指数得分比较差异未见统计学意义(P>0.05);术后3个月,两组巴氏功能活动指数、巴氏病情活动指数得分均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。术前,两组LL、PI、PT、SS、SVA比较,差异未见统计学意义(P>0.05);术后3个月,两组患者LL、PT、SS、SVA均降低,组间比较差异未见统计学意义(P>0.05)。术前,两组VAS、ODI评分比较差异未见统计学意义(P>0.05);术后3个月,两组VAS、ODI评分均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。结论腰椎侧前方入路手术治疗退行性腰椎滑脱患者可有效促进脊柱功能恢复,且对脊柱-骨盆矢状面形态影响较小。

Objective To investigate the effect of anterolateral lumbar approach on spinal function and sagittal parameters of spine pelvis in patients with degenerative lumbar spondylolisthesis.Methods From March 2016 to August 2019,70 patients with degenerative lumbar spondylolisthesis were selected as the research objects.According to the operation method,they were divided into control group(35 cases)and observation group(37 cases).The control group was treated with lumbar spondylolisthesis reduction surgery,and the observation group was treated with lumbar lateral anterior approach surgery.The operation time,intraoperative blood loss and postoperative drainage volume were observed.At 3 months after operation,the spinal function(PAP functional activity index and Pap disease activity index),spinal pelvic sagittal plane parameters[lumbar lordosis angle(LL),pelvic incidence angle(PI),pelvic tilt angle(PT),sacral tilt angle(SS),spinal sagittal plane balance(SVA)],visual analogue scale(VAS)of low back pain and lower limb pain,Lumbar 0-swesty disability index(ODI)were measured.Results The operation time,intraoperative blood loss and postoperative drainage of the observation group were significantly lower than those of the control group(P<0.05).Before operation,there was no significant difference in scores of PAP functional activity index and Pap disease activity index between the two groups(P>0.05).Three months after operation,the scores of PAP functional activity index and Pap disease activity index of the two groups were decreased,and that of the observation group was lower than that of the control group,the differences were significant(P<0.05).Before operation,there was no significant difference in LL,PI,Pt,SS and SVA between the two groups(P>0.05);At 3 months after operation,LL,Pt,SS and SVA of the two groups were decreased,and the differences were not significant(P>0.05).There was no significant difference between the two groups(P>0.05).At 3 months after operation,LL,Pt,SS and SVA of the two groups were decreased,and the differences were not significant(P>0.05).There was no significant difference between the two groups(P>0.05).Before operation,there was no significant difference in VAS and ODI scores between the two groups(P>0.05).Three months after operation,the VAS and ODI scores of the two groups were decreased,and those of the observation group were lower than those of the control group,the differences were significant(P<0.05).Conclusions Anterolateral lumbar approach in the treatment of degenerative lumbar spondylolisthesis can effectively promote the recovery of spinal function,and has little effect on the sagittal shape of spine pelvis.