摘要
目的探讨腰椎侧方椎间融合术(lateral lumbar interbody fusion,LLIF)与腰椎后路椎间融合术(posterior lumbar interbody fusion,PLIF)治疗重度腰椎椎管狭窄症的临床疗效。方法回顾性分析2019年2月至2023年12月因重度腰椎椎管狭窄症行LLIF或PLIF治疗的患者资料。LLIF组30例,男10例、女20例,年龄(62.7±5.6)岁(范围53~74岁),单节段21例、双节段9例。PLIF组46例,男20例、女26例,年龄(63.2±8.4)岁(范围43~75岁),单节段40例,双节段6例。比较两组患者疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎间隙高度、椎间孔高度及术后并发症发生情况。结果所有患者均获得随访,随访时间为(21.3±6.4)个月(范围12~32个月)。LLIF组术中失血量为(112.2±76.9)ml,低于PLIF组的(193.9±88.2)ml,差异有统计学意义(P<0.05)。两组术后腰痛、腿痛VAS评分均小于术前(P<0.05)。术前、术后6个月、末次随访的腰痛VAS评分组间差异无统计学意义(P>0.05);LLIF组术后1个月腰痛VAS评分为(1.6±1.2)分,小于PLIF组的(2.8±0.7)分(P<0.05)。术前、术后1个月、术后6个月腿痛VAS评分的组间差异无统计学意义(P>0.05);LLIF组末次随访时的腿痛VAS评分为(1.2±1.5)分,小于PLIF组的(1.8±1.0)分(P<0.05)。两组术后ODI均小于术前,差异有统计学意义(P<0.05);LLIF组术前、术后1个月、术后6个月、末次随访的ODI分别为45.7%±16.0%、17.9%±12.0%、16.2%±11.6%、15.7%±11.7%,PLIF组为47.9%±15.4%、20.1%±9.3%、16.9%±10.6%、14.6%±11.0%,组间差异无统计学意义(P>0.05);LLIF组术前椎间隙高度为(10.6±2.0)mm,小于PLIF组的(11.8±2.2)mm,差异有统计学意义(P<0.05)。LLIF组术后即刻及末次随访的椎间隙高度分别为(13.3±2.3)mm和(12.3±2.2)mm,PLIF组为(13.7±1.7)mm和(13.0±1.9)mm,组间差异无统计学意义(P>0.05)。LLIF组术前椎间孔高度为(18.0±3.2)mm,小于PLIF组的(19.7±2.4)mm,差异有统计学意义(P<0.05);LLIF组术后即刻及末次随访的椎间孔高度分别为(21.4±2.5)mm和(20.2±2.4)mm,PLIF组为(20.7±2.4)mm、(19.7±2.6)mm,组间差异无统计学意义(P>0.05)。LLIF组2例出现股神经损伤,2例术后出现一过性腰痛;PLIF组2例出现脑脊液漏,1例出现螺钉松动,2例出现深静脉血栓形成。PLIF组2例术后接受翻修,其中1例因融合器移位、1例因螺钉位置不良。LLIF组融合器沉降率为21%(8/39)、PLIF组融合器沉降率12%(6/52),差异无统计学意义(P>0.05)。结论LLIF与PLIF治疗重度腰椎椎管狭窄症均能有效恢复椎间高度,改善腰椎功能及腰腿痛症状。
ObjectiveTo investigate the clinical efficacy of lumbar lateral interbody fusion(LLIF)versus posterior lumbar interbody fusion(PLIF)in the treatment of severe lumbar spinal stenosis.MethodsThe data of patients with severe lumbar spinal stenosis who underwent LLIF or PLIF from February 2019 to December 2023 were retrospectively analyzed.There were 30 patients in the LLIF group,10 males and 20 females,aged 62.7±5.6 years(range,53-74 years),including 21 cases of single segment and 9 cases of double segment.There were 46 patients in the PLIF group,including 20 males and 26 females,aged 63.2±8.4 years(range,43-75 years),40 cases of single segment and 6 cases of double segment.The visual analogue scale(VAS),Oswestry disability index(ODI),intervertebral space height,intervertebral foramen height and postoperative complications were compared between the two groups.ResultsAll patients were followed up for an average of 21.3±6.4 months(range,12-32 months).The intraoperative blood loss in the LLIF group was 112.2±76.9 ml,which was significantly lower than 193.9±88.2 ml in the PLIF group(P<0.05).The VAS scores of back pain and leg pain after operation were significantly lower than those before operation in the two groups(P<0.05).There was no statistically significant difference between groups in back pain VAS scores at preoperative,6 months postoperative,and final follow-up(P>0.05);the back pain VAS score at 1 month postoperatively in the LLIF group was 1.6±1.2,which was less than 2.8±0.7 in the PLIF group(P<0.05).There was no statistically significant difference between groups in leg pain VAS scores at preoperative,1 month postoperative,and 6 months postoperative(P>0.05);the leg pain VAS score at the final follow-up in the LLIF group was 1.2±1.5,which was smaller than 1.8±1.0 in the PLIF group(P<0.05).The postoperative ODI was smaller than the preoperative one in both groups,and the difference was statistically significant(P<0.05);the preoperative,1-month postoperative,6-month postoperative,and final follow-up ODIs in the LLIF group were 45.7%±16.0%,17.9%±12.0%,16.2%±11.6%,and 15.7%±11.7%,and those in the PLIF group were 47.9%±15.4%,20.1%±9.3%,16.9%±10.6%,and 14.6%±11.0%in the PLIF group,and the difference between the groups was not statistically significant(P>0.05).The preoperative intervertebral space height in the LLIF group was 10.6±2.0 mm,which was smaller than that in the PLIF group 11.8±2.2 mm(P<0.05).The intervertebral space heights in the immediate postoperative period and at the final follow-up were 13.3±2.3 mm and 12.3±2.2 mm in the LLIF group and 13.7±1.7 mm and 13.0±1.9 mm in the PLIF group(P>0.05).The preoperative intervertebral foraminal height in the LLIF group was 18.0±3.2 mm,which was smaller than that of 19.7±2.4 mm in the PLIF group(P<0.05);the intervertebral foraminal heights in the immediate postoperative period and at the final follow-up were 21.4±2.5 mm and 20.2±2.4 mm in the LLIF group,and in the PLIF group were 20.7±2.4 mm and 19.7±2.6 mm in the PLIF group(P>0.05).In the LLIF group,2 cases had femoral nerve injury and 2 cases had transient back pain after operation.There were 2 cases of cerebrospinal fluid leakage,1 case of screw loosening,and 2 cases of deep vein thrombosis in the PLIF group.In the PLIF group,2 patients underwent revision,including 1 case due to cage displacement and 1 case due to screw malposition.The fusion settling rate was 21%(8/39)in the LLIF group and 12%(6/52)in the PLIF group(P>0.05).ConclusionBoth LLIF and PLIF can effectively restore the intervertebral height,improve the lumbar function and the symptoms of back and leg pain in the treatment of severe lumbar spinal stenosis.
作者
陈兵
陈超
李小鹏
边汉明
万文涛
刘钢
赵栋
杨海云
孙立民
徐宝山
方向前
马信龙
杨强
Chen Bing;Chen Chao;Li Xiaopeng;Bian Hanming;Wan Wentao;Liu Gang;Zhao Dong;Yang Haiyun;Sun Limin;Xu Baoshan;Fang Xiangqian;Ma Xinlong;Yang Qiang(Clinical College of Orthopaedics,Tianjin Medical University,Tianjin 300070,China;Department of Spine Surgery,Shandong Provincial Third Hospital Affiliated to Shandong University,Jinan 250100,China;Department of Spine Surgery,Tianjin Hospital,Tianjin University,Tianjin 300211,China;Department of Orthopaedics,Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310016,China)
出处
《中华骨科杂志》
北大核心
2025年第9期596-603,共8页
Chinese Journal of Orthopaedics
基金
天津市科技重大专项与工程揭榜挂帅重大项目(21ZXJBSY00130)
京津冀基础研究合作专项项目(23JCZXJC00010)。
关键词
腰椎
椎管狭窄
减压术
外科
Lumbar vertebrae
Spinal stenosis
Decompression,surgical
