腰椎融合术中恢复椎间隙自然高度对手术疗效的影响

Effect of restoring natural height of intervertebral space during lumbar fusion on surgical efficacy

目的 探讨腰椎融合术中恢复椎间隙自然高度对手术疗效的影响。方法 测量100名健康志愿者腰椎各椎间隙高度和椎体高度,计算各椎间隙高度与椎体高度的比值及其95%置信区间(CI),并以此为正常值参考标准,将2019年6月-2021年6月接受腰椎后路融合术治疗的133例患者根据手术节段术后椎间隙高度与椎体高度比值是否在正常值95%CI内分为自然高度组(n=78)和非自然高度组(n=55)。记录并统计2组患者术中及术后并发症发生率,采用疼痛视觉模拟量表评分(VAS)和日本骨科学会(JOA)评分评估手术前后疼痛程度及神经功能。结果 末次随访时,自然高度组发生邻椎病3例,并发症发生率为3.8%;非自然高度组发生邻椎病5例,足下垂1例,并发症发生率为10.9%;2组并发症发生率差异有统计学意义(P <0.05)。2组术后各随访时间点腰腿痛VAS评分、JOA评分较术前明显改善,末次随访时自然高度组腰腿痛VAS评分、JOA评分改善率优于非自然高度组,差异均有统计学意义(P <0.05)。结论 腰椎融合术中椎间隙的撑开高度应参照椎体自身高度,控制手术节段的椎间隙高度与椎体高度比值在正常值95%CI内可有效改善神经功能并降低并发症发生率。

Objective To explore the impact of restoring the natural height of the intervertebral space during lumbar fusion on the surgical efficacy.Methods The lumbar intervertebral height and vertebral body height of 100 healthy volunteers were measured,and the ratio of intervertebral height to vertebral body height and its 95%confidence interval(CI)were calculated,and used as the normal reference standard.A total of 133 patients who underwent posterior lumbar fusion from June 2019 to June 2021 were divided into natural height group(n=78)and unnatural height group(n=55)according to whether the ratio of space height to body height after surgery was within 95%CI of the normal value.The incidence of intraoperative and postoperative complications in the 2 groups were recorded and analyzed.Pain intensity and nerve function were evaluated by visual analogue scale(VAS)scoreand JapaneseOrthopaedic Association(JOA)score.ResultsAt thefinal follow-up,therewere3cases of adjacent vertebral diseases in the natural height group,with a complication rate of 3.8%;there were 5 cases of adjacent vertebral diseases and 1of foot drop in the unnatural height group,with a complication rate of 10.9%;there was a statistically significant difference in the incidence of complications between the 2 groups(P<0.05).The VAS and JOA scores of low back and leg pain in the 2 groups were significantly improved at each follow-up time point,and the improvement rate of JOA score in the natural height group was significantly higher compared with that in the unnatural height group at the final follow-up,all with a statistical significance(P<0.05).Conclusions The height of the vertebral space during lumbar fusion should be compared with the height of the vertebral body.Controlling the ratio of the height of the vertebral space to the height of the vertebral body within 95%CI of the normal value can effectively improve nerve function and reduce the incidence of complications.