保留棘突韧带复合体治疗腰椎退变性疾病的临床效果
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摘要
目的探讨保留棘突韧带复合体治疗腰椎退变性疾病的临床效果。方法回顾性分析2010年6月~2014年12月采取保留棘突韧带复合体治疗腰椎退变性病变的26例患者的临床资料,记录术前与末次随访的VAS、JOA以及ODI评分;分析融合邻近节段UCLA分型的进展情况。结果随访6~36个月,VAS评分术前为(8.00±0.75)分,末次随访为(1.10±1.05)分,差异有统计学意义(P<0.001);JOA评分术前为(7.45±5.73)分,末次随访为(23.10±3.05)分,差异有统计学意义(P<0.001);ODI评分术前为(30.10±10.40)分,末次随访为(5.10±3.20)分,差异有统计学意义(P<0.001)。临床结果以Mac-Nab标准评定,优22例,良2例,可2例,优良率为92.3%。26例患者中,24例融合邻近节段UCLA分型无进展,1例患者由术前B级进展为C级,1例患者由术前C级进展为D级,无一例需要手术治疗。结论保留棘突韧带复合体治疗腰椎退变性疾病在有效减压、松解神经根、融合手术节段的同时,可有效保护腰椎的稳定性,减少邻近节段退变(ASD),临床疗效满意。
Objective To investigate the clinical efficacy of reserving spinous process ligament complex in the treatment of lumbar degenerative diseases.Methods From June 2010 to December 2014,26 cases clinical data of spinous process ligament complex treatment of lumbar degenerative disease was analyzed retrospectively,VAS,JOA and ODI scores were recorded Pre-operatively and at last follow-up.The progress of adjacent segment UCLA classification was analyzed.Results After follow-uped for 6-36 months,VAS score was imporved from(8.00±0.75) to(1.10±1.05) at the last followup,the difference was statistically significant(P<0.001); JOA score was improved from(7.45±5.73) points to(23.10±3.05) points at the last follow-up,the difference was statistically significant(P <0.001).ODI score was imporved from(30.10±10.40) points to(5.10±3.20) points at the last follow-up,the difference was statistically significant(P<0.001).The clinical results were evaluated by Mac-Nab criteria.The results were excellent in 22 cases,good in 2 cases and fair in 2 cases,with an excellent and good rate of 92.3%.According to UCLA,24 cases without progression,1 case progressed from level B to C,1 case progressed from C to D,there was no need for further surgery.Conclusion Reserving spinous process ligament complex in treatment of lumbar degenerative disease can achieve effective decompression,release nerve root compression,promote fusion,and can effectively protect the stability of lumbar spine,reduce adjacent segment degeneration(ASD),the clinical outcomes are satisfied.
Objective To investigate the clinical efficacy of reserving spinous process ligament complex in the treatment of lumbar degenerative diseases.Methods From June 2010 to December 2014,26 cases clinical data of spinous process ligament complex treatment of lumbar degenerative disease was analyzed retrospectively,VAS,JOA and ODI scores were recorded Pre-operatively and at last follow-up.The progress of adjacent segment UCLA classification was analyzed.Results After follow-uped for 6-36 months,VAS score was imporved from(8.00±0.75) to(1.10±1.05) at the last followup,the difference was statistically significant(P<0.001); JOA score was improved from(7.45±5.73) points to(23.10±3.05) points at the last follow-up,the difference was statistically significant(P <0.001).ODI score was imporved from(30.10±10.40) points to(5.10±3.20) points at the last follow-up,the difference was statistically significant(P<0.001).The clinical results were evaluated by Mac-Nab criteria.The results were excellent in 22 cases,good in 2 cases and fair in 2 cases,with an excellent and good rate of 92.3%.According to UCLA,24 cases without progression,1 case progressed from level B to C,1 case progressed from C to D,there was no need for further surgery.Conclusion Reserving spinous process ligament complex in treatment of lumbar degenerative disease can achieve effective decompression,release nerve root compression,promote fusion,and can effectively protect the stability of lumbar spine,reduce adjacent segment degeneration(ASD),the clinical outcomes are satisfied.
引文
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[10]李超,阮狄克,何勍,等.腰椎减压融合术中保留头端后部韧带复合体结构完整性对相邻节段退变的影响[J].脊柱外科杂志,2016,14(5):262-266.
[11]田剑波,苏明宝.自锁稳定型椎间融合器前路融合术治疗退变性腰椎疾病的效果观察[J].中国当代医药,2016,23(22):85-87.
[12]任睿双,胡迪,晁建虎,等.保留后方韧带复合体椎间融合术治疗腰椎间盘突出症的疗效分析[J].中国骨与关节损伤杂志,2016,31(11):1192-1193.
[13]彭楷文,钟招明,陈建庭.腰椎融合术后邻近节段退变的研究进展[J].中国骨与关节损伤杂志,2017,32(7):782-783.
[14]何方生,吴兵,盛文辉,等.后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响[J].实用骨科杂志,2016,22(2):100-102.
[15]Yee TJ,SW,La Marca F,et al.Comparison of adjacent segment disease after minimally invasive or open transforaminal lumbar interbody fusion[J].J Clin Neurosci,2014,21(10):1801.
[2]Fukui M,Chiba K,Kawakami M,et al.Japanese Orthopaedic Association Cerical Myelopathy Evaluation Questionnaire(JOACMEQ):part 4.Establishment of equations for severity Scores.Subcommiettee on low back pain and cervical myelopathy,evaluation of the clinical outcome committee of the Jananese Orthopaedic Association[J].J Orthop Sci,2008,13(1):25-31.
[3]Suk S,Lee CK,Kim WJ,et al.Adding posterior lumbar interbody fusion to pedie screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthe-sis[J].Spine,1997,22(2):210-219.
[4]Ghiselli G,Wang JC,Bhatia NN,et al.Adjacent segment degeneration in the lumbar spine[J].J Bone Joint Surg Am,2004,86-A(7):1497-1503.
[5]杜国聪,李启中,毛萍,等.后路减压植骨融合内固定术治疗腰椎退行性疾病的疗效分析[J].中国骨与关节损伤杂志,2016,31(11):1190-1191.
[6]李明明,侯岩珂,王禹增.两种椎间融合手术对腰椎退变性疾病术后神经功能恢复的影响[J].中国实用神经疾病杂志,2015,18(3):24-25.
[7]王忠强,孔凡齐,李翔,等.后路钉棒固定椎间融合治疗腰椎退行性不稳并椎管狭窄[J].中国骨与关节损伤杂志,2015,30(1):13-14.
[8]汤长华,张晓慧,周晓宇,等.TLIL入路椎体间单枚融合植骨结合椎弓根钉系统内固定治疗多节段腰椎管狭窄症并腰椎不稳[J].中国骨与关节损伤杂志,2014,29(7):666-668.
[9]林定坤,陈树东,苏国义,等.经肌间隙入路经椎间孔腰椎椎体间融合术并椎管潜行减压治疗腰椎管狭窄症[J].广东医学2013,34(15):2336-2339.
[10]李超,阮狄克,何勍,等.腰椎减压融合术中保留头端后部韧带复合体结构完整性对相邻节段退变的影响[J].脊柱外科杂志,2016,14(5):262-266.
[11]田剑波,苏明宝.自锁稳定型椎间融合器前路融合术治疗退变性腰椎疾病的效果观察[J].中国当代医药,2016,23(22):85-87.
[12]任睿双,胡迪,晁建虎,等.保留后方韧带复合体椎间融合术治疗腰椎间盘突出症的疗效分析[J].中国骨与关节损伤杂志,2016,31(11):1192-1193.
[13]彭楷文,钟招明,陈建庭.腰椎融合术后邻近节段退变的研究进展[J].中国骨与关节损伤杂志,2017,32(7):782-783.
[14]何方生,吴兵,盛文辉,等.后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响[J].实用骨科杂志,2016,22(2):100-102.
[15]Yee TJ,SW,La Marca F,et al.Comparison of adjacent segment disease after minimally invasive or open transforaminal lumbar interbody fusion[J].J Clin Neurosci,2014,21(10):1801.