Topping-off手术与后路融合术治疗退变性腰椎疾病的临床治疗效果对比分析

Comparison of the clinical efficacy of Topping-off surgery and posterior interbody fusion in the treatment of degenerative lumbar disease

目的比较Topping-off手术与经后路椎间融合术(posterior interbody fusion,PIF)治疗退变性腰椎疾病(degenerative lumbar disease,DLD)的临床治疗效果。方法以2015年12月至2017年12月在首都医科大学宣武医院因DLD接受手术治疗的患者为研究对象,选择其中采用Topping-off术式治疗的40例患者为Topping-off组,按照组间主要基线特征匹配的原则选择采用PIF术式治疗的60例患者为PIF组。对所有患者术前及术后2年腰痛程度及腰椎功能进行评分,使用屈伸位腰椎X线片测量L2/3、L3/4及L2-4节段活动度(range of motion,ROM),使用改良Pfirrmann评分评估术前术后L2/3节段椎间盘退变程度。结果Topping-off组手术时间明显短于PIF组,差异有统计学意义(P<0.05);Topping-off组术中出血量小于PIF组,但差异无统计学意义(P>0.05)。术后2年Topping-off组L3/4节段ROM较术前降低(P<0.05),L2/3节段ROM较术前无明显改变(P>0.05);而PIF组L2/3节段ROM较术前显著增加(P<0.05)。两组间L2-4节段术后2年ROM差异无统计学意义(P>0.05)。在术后2年,PIF组L2/3节段改良Pfirrmann评分较Topping-off组高,组间差异有统计学意义(P<0.05)。结论Topping-off术与PIF术均能显著改善DLD预后,但Topping-off手术能预防或延缓邻近节段退变发生,对临床诊疗策略选择有重要指导意义。

Objective To compare the clinical efficacy of Topping-off surgery with posterior interbody fusion(PIF)in treating degenerative lumbar disease(DLD).Methods Patients who underwent surgery for DLD in Xuanwu Hospital,Capital Medical University from December 2015 to December 2017 were retrospectively reviewed and 40 patients undergoing Topping-off surgery were included.Sixty patients with matched demographic characteristics but undergoing posterior interbody fusion(PIF)surgery were included.All patients were graded for low back pain and lumbar function before and 2 years after surgery.The range of motion(ROM)of L2/3,L3/4,and L2-4 segments were measured with the dynamic lumbar X-rays,and the severity of disc degeneration in L2/3 was assessed with the modified Pfirrmann system.Results The surgical duration in the Topping-off group was significantly shorter than that in the PIF group(P<0.05).The intraoperative blood loss in the Topping-off group was non-significantly less than that in the PIF group(P>0.05).In the Topping-off group,the ROM of the L3/4 segment at two years after surgery was lower than that before surgery(P<0.05),but the ROM of the L2/3 segment was not significantly changed(P>0.05).In the PIF group,the ROM of the L2/3 segment increased significantly at two years after surgery compared with that before surgery(P<0.05).At two years after surgery,no significant difference was detected in the ROM of the L2-4 segment between the two groups(P>0.05),but the modified Pfirrmann score of the L2/3 segment in the PIF group was higher than that in the Topping-off group(P<0.05).Conclusion Both Topping-off surgery and PIF can significantly improve the prognosis of DLD,but Topping-off surgery can prevent or delay the occurrence of adjacent segment degeneration,which is of great significance to the selection of clinical diagnosis and treatment strategies.