改良侧方入路腰椎椎间融合术联合侧方钢板螺钉或双侧椎弓根螺钉内固定治疗骨量减少的单节段腰椎退行性疾病

Modified lateral lumbar interbody fusion combined with lateral plate-screw or bilateral pedicle screw internal fixation for treatment of single-segment lumbar degenerative diseases with osteopenia

目的探讨改良侧方入路腰椎椎间融合术(mLLIF)联合侧方钢板螺钉或双侧椎弓根螺钉内固定治疗骨量减少的单节段腰椎退行性疾病(LDD)的临床疗效。方法2020年2月—2023年2月,银川国龙骨科医院收治骨量减少的单节段LDD患者39例,其中22例采用mLLIF联合侧方钢板螺钉治疗(LP组),17例采用mLLIF联合双侧椎弓根螺钉治疗(BPS组)。记录2组手术时间、术中出血量、术中透视次数、切口总长度和术后住院时间等临床指标;术前、术后3 d及术后6个月采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评价患者疼痛程度和功能状态。在术前、术后3 d及术后6个月X线片上测量手术节段椎间盘高度(DH)、椎间孔高度(FH)、节段前凸角(SL)及腰椎前凸角(LL)。结果所有手术顺利完成。LP组手术时间、术中出血量、术中透视次数、切口总长度和术后住院时间优于BPS组,差异均有统计学意义(P<0.05)。2组术后腰痛、下肢痛VAS评分及ODI较术前改善,LP组术后3 d腰痛VAS评分优于BPS组,BPS组术后6个月ODI优于LP组,差异均有统计学意义(P<0.05)。2组术后DH、FH、LL、SL较术前改善,且BPS组DH、FH丢失率小于LP组,差异均有统计学意义(P<0.05)。术后6个月LP组椎间融合率为90.91%(20/22)、融合器沉降率为36.36%,BPS组椎间融合率为94.18%(16/17)、融合器沉降率为41.18%,组间差异均无统计学意义(P>0.05)。结论mLLIF联合LP或BPS治疗骨量减少的单节段LDD均可取得满意的早期临床疗效,mLLIF联合LP具有微创、手术时间短、术中出血量少及术后恢复快等优点,但mLLIF联合BPS在促进椎间融合、维持间接减压、预防椎间融合器沉降方面更具优势。

Objective To explore the clinical efficacy of modified lateral lumbar interbody fusion(mLLIF)combined with lateral plate-screw or bilateral pedicle screw internal fixation for treatment of single-segment lumbar degenerative diseases(LDD)with osteopenia.Methods From February 2020 to February 2023,39 patients with single-segment LDD and osteopenia treated in Yinchuan Guolong Orthopedic Hospital were admitted.Among them,22 cases were treated with mLLIF combined with lateral plate-screw(LP group),and 17 were treated with mLLIF combined with bilateral pedicle screw(BPS group).Clinical indicators such as operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,total incision length and postoperative hospital stay of 2 groups were recorded.Pain intensity and functional status of patients were evaluated using the visual analog scale(VAS)score and Oswestry disability index(ODI)at pre-operation,postoperative 3 d and postoperative 6 months.The disc height(DH),foramen height(FH)and segmental lordosis(SL)of the operative semgent,and lumbar lordosis(LL)was measured on roentgenographs at pre-operation,postoperative 3 d and postoperative 6 months.Results All the surgeries were completed successfully.The LP group had better operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,total incision length and postoperative hospital stay than the BPS group,with statistically significant differences(P<0.05).The VAS scores of low back pain and lower limb pain and ODI in both groups at post-operation improved compared to pre-operation,and the VAS score of low back pain in the LP group was better than that in the BPS group at postoperative 3 d,and the ODI in the BPS group was better than that in the LP group at postoperative 6 months,all with a statistical significance(P<0.05).The DH,FH,LL and SL of the 2 groups at post-operation improved compared to pre-operation,and the loss rate of DH and FH in the BPS group was lower than that in the LP group,all with a statistical significance(P<0.05).At postoperative 6 months,the fusion rate in the LP group was 90.91%,and the cage settlement rate was 36.36%;in the BPS group,the fusion rate was 94.18%,and the cage settlement rate was 41.18%,without statistical significance(P>0.05).Conclusions mLLIF combined with LP or BPS can achieve satisfactory early clinical efficacy in the treatment of single-segment LDD with osteopenia.mLLIF combined with LP has advantages such as minimally invasive,short operation time,low intraoperative blood loss and fast postoperative recovery.However,mLLIF combined with BPS has more advantages in promoting fusion,maintaining indirect decompression,and preventing cage subsidence.