经后路开窗减压矫形融合内固定术治疗DLSS合并LS患者的临床疗效

Clinical Outcomes of DLSS Combined with LS in Patients Treated by Posterior Open-Loop Decompression Orthopedic Fusion Internal Fixation

目的:探讨经后路开窗减压矫形融合内固定术(PLIF)治疗退变性腰椎椎管狭窄(DLSS)合并节段性腰椎不稳定(LS)患者的临床疗效。方法:选取109例DLSS合并LS患者为研究对象,随机分为观察组(n=55)及对照组(n=54),对照组采用全椎板切除(LAM)椎间融合IF治疗,观察组采用PLIF治疗,比较两种不同术式对患者腰椎稳定性、脊柱矢状面形态、腰椎功能障碍的影响,记录并发症。结果:两组术后1年椎体融合情况比较,差异有统计学意义(P<0.05);观察组术中失血量显著低于对照组,手术、卧床、住院时间低于对照组,切口长度短于对照组,差异有统计学意义(P<0.05);术后两组腰椎前凸角(LL)、失状垂直轴(SVA)、骨盆投射角(PI)、胸椎后凸角(TK)、骨盆倾斜角(PT)均显著降低,但两组手术前后以上指标差值均比较,差异无统计学意义(P>0.05);术后两组脊柱功能障碍评分(ODI)、疼痛评分(VAS)均显著降低,人体功能障碍性程度评分(JOA)、椎间隙高度、椎间孔高度、腰椎前凸角升高,且两组手术前后以上指标差值比较,差异有统计学意义(P<0.05)。结论:在DLSS合并LS患者临床治疗中,PLIF与LAM椎间融合IF在椎管融合、脊柱形态改善方面效果相当,但前者创伤小、疼痛程度低、失血少,更能有效促进肢体功能恢复,值得在临床推广。

Objective:To investigate the clinical efficacy of posterior fenestration,decompression,orthopedic fusion and internal fixation(PLIF)in the treatment of DLSS combined with LS.Methods:109 patients with DLSS and LS were randomly divided into observation group(n=55)and control group(n=54).The control group was treated with total laminectomy(LAM)and intervertebral fusion IF,and the observation group was treated with PLIF.The effects of different surgical methods on lumbar stability,sagittal spine morphology lumbar dysfunction were compared.And complications were recorded.Results:There was a significant difference between the two groups in terms of vertebral fusion one year after operation(P<0.05).The intraoperative blood loss in the observation group was significantly lower than that in the control group,the operation,bed rest and hospitalization time were lower than that in the control group,and the incision length was shorter than that in the control group(P<0.05).After surgery,lumbar lordosis angle(LL),shapeless vertical axis(SVA),pelvic incidence(PI),thoracic kyphosis angle(TK)and pelvic tilt angle(PT)in both groups were significantly decreased,but there was no significant difference between the two groups in the above indexes before and after operation(P>0.05).After operation,the spinal dysfunction score(ODI)and pain score(VAS)of the two groups were significantly decreased,and the human dysfunction score(JOA),intervertebral space height,intervertebral foramen height,and lumbar lordosis angle were increased.The difference of the above indexes before and after operation between the two groups was statistically significant(P<0.05)Conclusion:In the clinical treatment of patients with DLSS and LS,PLIF and LAM interbody fusion IF have the same effect in spinal canal fusion and spinal morphology improvement,but the former has less trauma,low pain and less blood loss,and can effectively promote the recovery of limb function,which is worthy of clinical promotion.