椎间融合术治疗腰椎间盘突出症术后复发的临床研究

Clinical study on the treatment of postoperative recurrence of lumbar disc herniation with intervertebral fusion

目的:探究不同椎间融合器(cage)治疗术后复发的腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:回顾性分析2019年1月至2021年1月142例行单纯椎间盘髓核摘除术后复发的LDH患者,均采用通道下联合固定并椎间融合术治疗,根据植入cage类型及数目不同分为单枚解剖组、2枚解剖组和单枚香蕉组。单枚解剖组51例,男29例,女22例;年龄39~65(53.74±5.68)岁;身体质量指数(body mass index,BMI)18.62~28.13(22.08±2.15)kg·m-2;手术与复发间隔时间0.5~4.0(2.7±0.8)年;L3,45例,L4,535例,L5S111例;植入单枚解剖型cage。2枚解剖组46例,男25例,女21例;年龄37~66(54.15±6.02)岁;BMI为18.25~28.44(21.74±1.83)kg·m-2;手术与复发间隔时间0.5~5.0(2.7±0.9)年;L3,44例,L4,532例,L5S110例;植入2枚解剖型cage。单枚香蕉组45例,男22例,女23例;年龄38~65(54.49±6.45)岁;BMI为18.85~28.20(21.63±1.59)kg·m-2;手术与复发间隔时间0.5~5.0(2.6±1.0)年;L3,43例,L4,536例,L5S16例;植入单枚香蕉型cage。观察并比较3组手术时间、术中出血量、切口长度、术后切口引流量、住院时间、并发症等情况;比较手术前后椎间隙高度、前凸曲度及术后椎间融合情况;分别于术前、术后1和6个月采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)对腰部疼痛程度、腰椎功能进行临床疗效评价。结果:3组患者均获得至少6个月随访,无病例脱落。3组手术时间、术中出血量、切口长度、术后切口引流量、住院时间比较,差异无统计学意义(P>0.05)。2枚解剖组、单枚香蕉组术后6个月融合节段椎间隙高度[(11.08±1.78)mm、(10.95±1.62)mm]、前凸曲度[(12.05±1.86)°、(11.63±1.57)°],高于单枚解剖组(10.14±1.54)mm、(10.92±1.45)°,差异有统计学意义(P<0.05);2枚解剖组、单枚香蕉组术后6个月椎间融合率(95.65%、95.56%),高于单枚解剖组(78.43%);3组术后1、6个月腰部VAS、ODI较术前下降(P<0.05);3组并发症比较,差异无统计学意义(P>0.05)。结论:3种融合器治疗LDH术后复发均能取得显著效果,但植入2枚解剖型cage和单枚香蕉型cage更有助于维持LDH术后复发患者椎间隙高度、前凸曲度,可获得良好椎间融合效果。

Objective To explore clinical effect of different intervertebral fusion devices(cage)in treating postoperative recurrent lumbar disc herniation(LDH).Methods One hundred and forty-two LDH patients with recurrence after simple intervertebral disc nucleus pulpoideectomy from January 2019 to January 2021 were retrospectively analyzed.All patients were treated with combined underchannel fixation and interbody fusion and divided into a single anatomical group,two-anatomical group and a single banana group according to types and numbers of implanted cage.There were 51 patients in a single anatomical group,included 29 males and 22 females,aged from 39 to 65 years old with an average of(53.74±5.68)years old;body mass index(BMI)ranged from 18.62 to 28.13 kg·m-2 with an average of(22.08±2.15)kg·m-2;the interval between operation and recurrence ranged from 0.5 to 4.0 years with an average of(2.7±0.8)years;5 patients with L3,4,35 patients with L4,5 and 11 patients with L5S1;a single anatomical cage was implanted.There were 46 patients in two-anatomical group,included 25 males and 21 females,aged from 37 to 66 years old with an average of(54.52±6.02)years old;BMI ranged from 18.25 to 28.44 kg·m-2 with an average of(21.74±1.83)kg·m-2;the interval between operation and recurrence ranged from 0.5 to 5.0 years with an average of(2.7±0.9)years;4 patients with L3,4,32 patients with L4,5 and 10 patients with L5S1;two-anatomical cages were implanted.There were 45 patients in a single banana group,included 22 males and 23 females,aged from 38 to 65 years old with an average of(54.49±6.45)years old;BMI ranged from 18.85 to 28.20 kg·m-2 with an average of(21.63±1.59)kg·m-2;the interval between operation and recurrence ranged from 0.5 to 5.0 years with an average of(2.6±1.0)years;3 patients with L3,4,36 patients with L4,5 and 16 patients with L5S1;a single banana cage was implanted.Operation time,intraoperative blood loss,incision length,postoperative incision drainage volume,hospital stay and complications among 3 groups were observed and compared.The height of intervertebral space before and after operation,curvature of lordosis and the postoperative intervertebral fusion were compared.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate degree of lumbar pain and lumbar function before operation,1 and 6 months after operation,respectively.Results All patients among 3 groups were followed up at least 6 months,and no cases were fell out.There were no significant difference in operation time,intraoperative blood loss,incision length,postoperative incision drainage volume and hospital stay among 3 groups(P>0.05).At 6 months after operation,the height of intervertebral space in two-anatomical group and a single group were[(11.08±1.78)mm,(10.95±1.62)mm],curvature of lordosis were[(12.05±1.86)°,(11.63±1.57)°],which were higher than those in a single dissection group(10.14±1.54)mm,(10.92±1.45)°,and the difference were statistically significant(P<0.05).The interbody fusion rate between two-anatomical and a banana group(95.65%,95.56%)were higher than that in a single anatomical group(78.43%)at 6 months after operation(P<0.05).VAS and ODI of lumbar among 3 groups were decreased at 1 and 6 months after operation(P<0.05).There was no significant difference in complications among 3 groups(P>0.05).Conclusion The three fusion devices could achieve significant results in treating postoperative recurrence of LDH,but the implantation of two-anatomical cage and a single banana cage are more helpful to maintain the height of intervertebral space and lordosis curvature of patients with postoperative recurrence of LDH,and obtain good intervertebral fusion results.