摘要
目的观察不同手术方法治疗腰椎后路减压融合内固定术后邻近节段退行性疾病的临床疗效,通过相关文献分析邻近节段退行性疾病发生原因及手术方式选择。方法回顾性分析自2013-02—2020-01手术治疗的28例腰椎后路减压融合内固定术后邻近节段腰椎退行性疾病,5例行后路腰椎间融合术,9例行经椎间孔腰椎间融合术,6例行侧路腰椎间融合术,8例行经皮脊柱内镜椎间盘切除术。结果28例均获得随访,随访时间平均22.5(12~48)个月。随访期间未出现假关节形成、融合器移位或沉降、螺钉断裂、螺钉松动,融合节段均获得骨性融合。术后第3天腰痛VAS评分、腿痛VAS评分、ODI指数较术前降低,术后12个月上述指标较术后第3天降低,差异有统计学意义(P<0.05)。末次随访时骨盆倾斜角、骨盆入射角、骶骨倾斜角与术前比较差异无统计学意义(P>0.05),而腰椎前凸角较术前增加,差异有统计学意义(P<0.05)。开放手术20例末次随访时改良MacNab标准评定结果:优14例,良5例,可1例。微创手术8例末次随访时改良MacNab标准评定结果:优4例,良3例,差1例。结论腰椎后路减压融合内固定术后并发邻近节段退行性疾病可能与患者腰椎前凸角存在相关性,然而文献报道的因素是多方面的,为了减少术后邻近节段退行性疾病的发生,临床医师应选择损伤程度更小的手术方式,以能够改善患者主要临床症状为主,术中尽量保护患者正常组织。
Objective To observe the clinical effects of different surgical methods for the treatment of adjacent segment degen-erative diseases following posterior lumbar fusion and analyze the etiology of adjacent segment degenerative diseases and the se-lection of surgical methods through relevant literature.Methods Twenty-eight cases of lumbar degenerative diseases of adja-cent segments following posterior decompression,fusion and internal fixation from February 2013 to January 2020 were retro-spectively analyzed.Five cases underwent posterior lumbar interbody fusion,9 cases underwent transforaminal lumbar inter-body fusion,6 cases underwent lateral lumbar interbody fusion,and 8 cases underwent percutaneous endoscopic discectomy.Results All 28 cases were followed up for an average of 22.5(12-48)months.During the follow-up period,no pseudarthrosis,cage displacement or subsidence,screw breakage,or screw loosening occurred,and all fusion segments achieved bony fusion.The low back pain VAS score,leg pain VAS score,and ODI index were lower on the 3rd day after operation than those before op-eration.The above indicators were significantly lower at 12 months after surgery than on the 3rd day after surgery.The differ-ence was statistically significant(P<0.05).At the last follow-up,the pelvic tilt angle,pelvic incidence angle,and sacral tilt an-gle were not significantly different from those before operation(P>0.05),but the lumbar lordotic angle increased compared with that before operation,and the difference was statistically significant(P<0.05).In 20 cases of open surgery,the modified MacNab standard evaluation results at the last follow-up:14 cases were excellent,5 cases were good,and 1 case was fair.The results of modified MacNab standard evaluation in 8 cases of minimally invasive surgery at last follow-up:4 cases were excellent,3 cases were good,and 1 case was poor.Conclusion The degenerative diseases of adjacent segments following posterior lumbar de-compression,fusion and internal fixation may be related to the lumbar lordosis angle,but there are many factors reported in the literature.In order to reduce the incidence of adjacent segment degenerative diseases after posterior lumbar decompression,fusion and internal fixation,clinicians should choose surgical methods with less damage,aim at improving the main clinical symptoms of patients,and try to protect patients'normal tissue during operation.
作者
巩陈
吴建明
刘向阳
胡伟
GONG Chen;WU Jianming;LIU Xiangyang;HU Wei(Department of Spinal Surgery,People's Hospital of Bozhou,Bozhou,Anhui 236800,China)
出处
《中国骨与关节损伤杂志》
2023年第5期458-462,共5页
Chinese Journal of Bone and Joint Injury
基金
安徽省重点研究与开发计划项目(202104j07020053)
亳州市人民医院三新项目(2021ZDA-01)。