单节段腰椎退变性疾病患者不同手术方式临床效果观察

Clinical Efficacy of Different Surgery Methods in the Treatment of Single Segmental Lumbar Degenerative Disease

目的比较改良的后路腰椎体间融合术(PLIF)与后路经椎间孔入路椎体间融合术(P-TLIF)治疗单节段腰椎退变性疾病的临床综合疗效。方法将150例单节段腰椎退变性患者分成两组,分别使用改良的PLIF手术与P-TLIF手术治疗,记录所有患者手术时间、术中出血量、椎间隙植骨量、术后住院时间、椎间融合率、术前和术后VAS评分及JOA评分。结果两组患者术后住院时间、椎间融合率差异无统计学意义(P>0.05);P-TLIF组术中出血量及手术时间均少于改良的PLIF组,P-TLIF组椎间隙植骨量多于改良的PLIF组(P均<0.05);改良的PLIF组术后1个月和术后3个月的VAS评分低于术前(P<0.05)。改良的PLIF组术后1个月和术后3个月的JOA评分高于术前(P<0.05),术后第1天VAS评分P-TLIF组低于改良的PLIF组(P<0.05),JOA评分差异无统计学意义(P>0.05);术后1、3个月随访两组间VAS评分及JOA评分差异均无统计学意义(P>0.05)。结论 P-TLIF治疗单节段腰椎退变性可以获得与改良PLIF手术相同的临床效果,且具有手术时间短、术中出血少、神经损伤轻等临床优势。

Objective To assess the clinical Efficacy of improved PLIF surgery and P-TLIF surgery for the treatment of single segmental lumbar degenerative disease.Methods 150 patients with single segmental lumbar degenerative disease were divided into two groups and treated with improved PLIF surgery and P-TLIF surgery,respectively.All patient data such as operation time,blood loss,interbody bone graft,hospital stay,interbody fusion rate were collected.Visual analogue scale(VAS)scores and Japanese orthopaedic association(JOA)scores were taken in preoperation and postoperation.Results Patients in two groups had no significantly different in hospital stay,interbody fusion rate(P>0.05),whereas blood loss of P-TLIF group was less significantly than that of improved PLIF group.Operation time of P-TLIF group was significantly shorter than that of improved PLIF while intervertebral bone graft of P-TLIF group was more than that of improved PLIF group(P<0.05).VAS score of P-TLIF group in 1 and 3 month of post-operation was significantly lower than that of pre-operation while JOA score of P-TLIF group in 1 and 3 month of post-operation was not significantly higher than pre-operation(P>0.05).VAS score of P-TLIF group was significantly lower than that of improved PLIF at 1 day after surgery.VAS score and JOA score showed no statistical significance at 1 and 3 months follow-up after surgery.Conclusion Both P-TLIF and improved PLIF can obtain the same clinical efficacy in treatment of patients with single segmental lumbar degenerative diseases.Nevertheless,P-TLIF has shorter operation time,and less blood loss and nerve injury.