斜外侧入路腰椎椎体间融合术治疗腰椎管狭窄症的效果

Efficacy of oblique lumbar interbody fusion for lumbar spinal stenosis

目的探讨斜外侧入路腰椎椎体间融合术治疗对腰椎管狭窄症患者围手术指标、创伤应激指标及Oswestry功能障碍指数量表(ODI)评分的影响。方法选取2016年12月—2019年12月漳州市某医院收治的90例腰椎管狭窄症患者,采用随机数字表法分为对照组(46例)与观察组(44例)。对照组患者采用后路腰椎椎体间融合术治疗,观察组患者采用斜外侧入路腰椎椎体间融合术治疗,比较2组患者围手术期指标,手术前后视觉模拟评分量表(VAS)评分、ODI评分、血清C反应蛋白(CRP)、肌酸激酶(CK)水平及术后并发症发生情况。结果观察组患者术中出血量、引流量少于对照组,下地活动时间、住院时间短于对照组,差异均有统计学意义(P<0.05)。2组患者术后3个月及术后6个月VAS、ODI评分低于术前,且观察组低于对照组,差异均有统计学意义(P<0.05)。2组患者术后12 h、24 h、48 h血清CRP、CK水平高于术前,术后48 h血清CRP、CK水平低于术后12 h、24 h,且观察组术后12 h、24 h、48 h血清CRP、CK水平均低于对照组,差异均有统计学意义(P<0.05)。观察组患者术后并发症发生率为4.55%(2/44),低于对照组的15.57%(9/46),差异有统计学意义(χ^(2)=4.729,P=0.030)。结论斜外侧入路腰椎椎体间融合术治疗腰椎管狭窄症安全性高于后入路手术,患者术后组织创伤应激反应小,术后疼痛感较轻,能促进患者腰椎功能恢复。

Objective To investigate the effects of oblique lumbar interbody fusion treatment on the perioperative indexes,traumatic stress indexes and Oswestry dysfunction index(ODI)scores of patients with lumbar spinal stenosis.Methods Ninety patients with lumbar spinal stenosis admitted to a hospital in Zhangzhou from Decem-ber 2016 to December 2019 were selected and divided into a control group(46 cases)and an observation group(44 cases)using a random number table.Patients in the control group were treated with posterior lumbar inter-body fusion and patients in the observation group were treated with oblique lumbar interbody fusion,and the perioperative indexes,pre-and postoperative visual analog scale(VAS)scores,ODI scores,serum C-reactive protein(CRP)and creatine kinase(CK)levels and postoperative complications in the two groups were compared.Results The intraoperative bleeding and drainage were less in the observation group than in the control group,and the time to ambulation and hospital stay were shorter than those in the control group,all with statistically significant differences(P<0.05).The VAS and ODI scores at 3 and 6 months after surgery were lower than those before surgery and lower in the observation group than in the control group,with statistically significant differences(P<0.05).The serum CRP and CK levels in the 2 groups were higher at 12 h,24 h and 48 h after surgery than before surgery,and lower the serum CRP and CK levels at 48 h after surgery than at 12 h and 24 h after surgery,and the serum CRP and CK levels in the observation group were lower than those in the control group at 12 h,24 h and 48 h after surgery,all with statistically significant differences(P<0.05).The incidence of postoperative complications was 4.55%(2/44)in the observation group,which was lower than that of 15.57%(9/46)in the control group,and the difference was statistically significant(χ^(2)=4.729,P=0.030).Conclusion Oblique lumbar interbody fusion for lumbar spinal stenosis is safer than the posterior approach,and patients have less postoperative tissue trauma stress and less postoperative pain,which can promote the recovery of lumbar spine function.