单侧椎弓根钉固定联合MISTLIF治疗退行性脊柱侧弯患者的效果观察

Effect of Unilateral Pedicle Nail Fixation Combined with MISTLIF in the Treatment of Patients with Degenerative Scoliosis

目的:探究单侧椎弓根钉固定联合微创经椎间孔入路椎间融合术(MISTLIF)治疗退行性脊柱侧弯的效果。方法:选取2017年1月—2023年5月西安市临潼区核工业417医院收治的80例退行性脊柱侧弯患者为研究对象,按照随机信封法分为对照组(n=38)和研究组(n=42)。两组均进行MISTLIF治疗,对照组采用双侧椎弓根钉固定治疗,研究组采用单侧椎弓根钉固定治疗,对比两组的围手术期指标、腰椎功能、脊柱状态、脊柱侧弯复发情况和植骨融合情况。结果:研究组手术时间短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05);术后3个月,两组腰椎ODI评分均低于术前,且研究组低于对照组,差异有统计学意义(P<0.05);术后6个月,两组腰椎前突角、骶骨倾斜角均高于术前,脊柱Cobb角低于术前,且研究组腰椎前突角、骶骨倾斜角均高于对照组,脊柱Cobb角低于对照组,差异均有统计学意义(P<0.05);术后12个月,研究组脊柱侧弯复发率4.76%与对照组的2.63%比较,差异无统计学意义(P>0.05);术后12个月,研究组植骨融合率95.24%高于对照组的76.32%,差异有统计学意义(P<0.05)。研究组术后12个月内脊柱侧弯复发率4.76%与对照组的2.63%比较,差异无统计学意义(P>0.05)。结论:单侧椎弓根钉固定联合MISTLIF治疗退行性脊柱侧弯,有助于促进患者植骨融合,缩短手术时间,减少术中出血量,矫正脊柱侧弯,改善腰椎功能。

Objective:To investigate the effect of unilateral pedicle nail fixation combined with minimally invasive transforaminal interbody fusion(MISTLIF)in the treatment of degenerative scoliosis.Methods:A total of 80 patients with degenerative scoliosis admitted to Lintong District Nuclear Industry 417 Hospital of Xi’an City from January 2017 to May 2023 were selected as the study objects,and were divided into a control group(n=38)and a study group(n=42)according to random envelope method.MISTLIF treatment was performed in both groups.The control group was treated with bilateral pedicle nail,while the study group was treated with unilateral pedicle nail.The perioperative indexes,lumbar function,spinal status,scoliosis recurrence and bone graft fusion were compared between the two groups.Results:The operation time of the study group was shorter than that of the control group,and the intraoperative blood loss was less than the control group,the differences were statistically significant(P<0.05);three months after surgery,the Oswestry disability index score of lumbar spine in both groups was lower than before surgery,and the study group was lower than that of the control group,the differences was statistically significant(P<0.05);six months after surgery,lumbar protrusion angle and sacral inclination angle were higher in both groups than those before surgery,and spine Cobb angle was lower than before surgery,and lumbar protrusion angle and sacral inclination angle in the study group were higher than the control group,and spine Cobb angle was lower than the control group,with statistical significance(P<0.05).At 12 months after operation,the recurrence rate of scoliosis in the study group was 4.76%,compared with 2.63%in the control group,there was no significant difference(P>0.05).Twelve months after surgery,the bone graft fusion rate in the study group was 95.24%,higher than 76.32%in the control group,the difference was statistically significant(P<0.05).The recurrence rate of scoliosis within 12 months after operation in the study group was 4.76%,compared with 2.63%in the control group,there was no significant difference(P>0.05).Conclusion:Unilateral pedicle nail fixation combined with MISTLIF in the treatment of degenerative scoliosis is helpful to promote bone graft fusion,shorten operation time,reduce intraoperative blood loss,correct scoliosis and improve lumbar function.