PLIF与TLIF治疗腰椎管狭窄症的中期效果及对腰椎前凸角变化的影响
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摘要
目的为探究单节段后路椎间融合术和经椎间孔入路椎间融合术治疗腰椎管狭窄症的中期效果,以及对腰椎前凸角变化的影响。方法回顾性分析我院治疗的腰椎管狭窄患者,按照治疗方法不同分为对照组和研究组。对照组患者采用TLIF进行治疗,研究组患者则采用PLIF进行治疗,手术前后测量两组患者腰椎前凸角(1umbar lordosis,LL)和融合阶段腰椎前凸角(segmental lumbar lordosis,SLL),分析比较两组患者临床疗效,如治疗前后的Oswestry功能障碍指数(Os-westry disability index,ODI)和腰腿疼痛VAS评分,测量腰椎正侧位和伸过去屈侧位X线片相邻节段的活动度,椎间隙高度等。随访期间观察两组患者不良发生率。结果手术前两组患者的LL和SLL角差异无统计学意义(P>0. 05),治疗后两项指标均有显著提高(P<0. 05),且研究组患者LL和SLL明显高于对照组患者,差异具有统计学意义(P<0. 05);此外,术后两组患者的腰3～4节段活动度比手术前有显著增加(P<0. 05),且研究组明显高于对照组,组间比较差异有统计学意义(P<0. 05);而两组腰3～4和腰5骶1椎间隙高度末次随访与术前比较有降低趋势,但无统计学意义(P>0. 05);此外,治疗后两组患者的腰痛VAS评分和ODI指数均有明显下降(P<0. 05),且研究组显著更低(P<0. 05),差异具有统计学意义;而随访期间研究组患者的不良反应发生率显著低于对照组(P<0. 05)。结论 PLIF和TLIF手术均对腰椎管狭窄症患者有较好的临床疗效,但PLIF效果更佳,术后对患者中期效果更优,不良反应发生率较低,能显著恢复腰椎前凸角的畸变程度,具有更大的临床应用价值。
Objective To explore the medium-term effect of single segment PLIF( posterior lumbar interbody fusion) and TLIF( transforaminal lumbar interbody fusion) in the treatment of lumbar spinal stenosis and their effect on lumbar lordosis. Methods The patients with lumbar spinal stenosis treated in our hospital were retrospectively analyzed,and divided into control group and study group according to different treatment methods. The patients in the control group were treated with TLIF,and the patients in the study group were given PLIF. The lumbar lordosis( LL) and the segmental lumbar lordosis( SLL) were measured before and after the operation. The curative effects of the two groups of patients were compared,such as the Oswestry disability index( ODI),and VAS score of low back pain before and after treatment. The activity of the adjacent segments of L-Spine PA & LAT and L-spine lordotic kyphotic position X ray,and disc height were also measured. The incidence of adverse events of the two groups was observed during the follow-up period. Results There was no statistically significant difference in LL and SLL between the two groups before operation( P >0. 05),and the two indexes were significantly improved after the treatment( P<0. 05). The LL and SLL in the study group were notably higher than those in the control group,with statistically significant difference( P<0. 05). In addition,the activity of the waist 3 ～4 segment of the two groups after the operation was remarkably higher than that before the operation( P<0. 05),and the study group featured obviously higher activity than the other group,with statistically significant difference between the two groups( P < 0. 05).The disc height of the waist 3 ～ 4 and the waist 5 sacral 1 of the two groups in the last follow-up was lower than that before the operation,but there was no statistical significance( P > 0. 05). The VAS score of low back pain and the ODI index in the two groups after treatment were strikingly lowered( P<0. 05),and those two indexes were markedly lower in the study group,with statistically significant difference( P<0. 05). The incidence of adverse reactions in the study group was significantly lower than that of the control group during the follow-up( P<0. 05). Conclusion Both PLIF and TLIF have great clinical efficacy on the patients with lumbar spinal stenosis. However,PLIF boasts of better curative effect,which brings better medium-term effect on patients after the operation and has lower incidence of adverse reactions. It can significantly improve the distortion of the lumbar lordosis with more clinical application value.
Objective To explore the medium-term effect of single segment PLIF( posterior lumbar interbody fusion) and TLIF( transforaminal lumbar interbody fusion) in the treatment of lumbar spinal stenosis and their effect on lumbar lordosis. Methods The patients with lumbar spinal stenosis treated in our hospital were retrospectively analyzed,and divided into control group and study group according to different treatment methods. The patients in the control group were treated with TLIF,and the patients in the study group were given PLIF. The lumbar lordosis( LL) and the segmental lumbar lordosis( SLL) were measured before and after the operation. The curative effects of the two groups of patients were compared,such as the Oswestry disability index( ODI),and VAS score of low back pain before and after treatment. The activity of the adjacent segments of L-Spine PA & LAT and L-spine lordotic kyphotic position X ray,and disc height were also measured. The incidence of adverse events of the two groups was observed during the follow-up period. Results There was no statistically significant difference in LL and SLL between the two groups before operation( P >0. 05),and the two indexes were significantly improved after the treatment( P<0. 05). The LL and SLL in the study group were notably higher than those in the control group,with statistically significant difference( P<0. 05). In addition,the activity of the waist 3 ～4 segment of the two groups after the operation was remarkably higher than that before the operation( P<0. 05),and the study group featured obviously higher activity than the other group,with statistically significant difference between the two groups( P < 0. 05).The disc height of the waist 3 ～ 4 and the waist 5 sacral 1 of the two groups in the last follow-up was lower than that before the operation,but there was no statistical significance( P > 0. 05). The VAS score of low back pain and the ODI index in the two groups after treatment were strikingly lowered( P<0. 05),and those two indexes were markedly lower in the study group,with statistically significant difference( P<0. 05). The incidence of adverse reactions in the study group was significantly lower than that of the control group during the follow-up( P<0. 05). Conclusion Both PLIF and TLIF have great clinical efficacy on the patients with lumbar spinal stenosis. However,PLIF boasts of better curative effect,which brings better medium-term effect on patients after the operation and has lower incidence of adverse reactions. It can significantly improve the distortion of the lumbar lordosis with more clinical application value.
引文
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[5]张伟彬,陈扬,杨欣建,等.经椎间孔腰椎椎间融合术与PLIF治疗单节段腰椎间盘突出症的临床疗效比较[J].中国骨与关节损伤杂志,2016,31(1):13-15.
[6]邹海波,绳厚福,李中实,等. TLIF单侧或双侧固定治疗腰椎退行性疾病的临床疗效[J].中国脊柱脊髓杂志,2013,23(12):1086-1091.
[7]顾叶,徐耀增,耿德春,等. Coflex与PLIF治疗腰椎退行性疾患的对比研究[J].实用骨科杂志,2014,20(2):97-101.
[8]冯强,周誉.脊柱测量尺和Spinal Mouse脊柱测量仪测量胸椎后凸角、腰椎前凸角的信度和效度[J].中国运动医学杂志,2017,36(2):150-155.
[9]李卫东,崔志明,徐冠华,等. Mast Quadtrant可扩张管通道手术系统治疗腰椎管狭窄症[J].脊柱外科杂志,2010,8(8):207-210.
[10] Ringel F,Stoffel M,Stuer C,et al. Minimally invasive trans-muscular pedicle screw fixation of the thoracic an lunbar spine[J]. Neurosurgery,2006,59(4):S361-366,367.
[11]戈浩,吕建军. PLIF与TLIF治疗老年退变性腰椎滑脱合并腰椎管狭窄症的疗效比较[J].湖南师范大学学报(医学版),2016,13(6):41-44.
[12]郭德立,刘欣,李涛,等. TLIF与PLIF对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效[J].现代生物医学进展,2017,16(32):3125-3128.
[13]田伟,李加宁,韩骁,等. TLIF与PLIF治疗老年退变性腰椎滑脱并椎管狭窄症的比较[J].中国矫形外科杂志,2017,25(17):1537-1540.
[2] Gejo R,Matsui H,Kawaguchi Y,et al. Serial changes in trunkmuscle performance after posterior lumbar surgery[J]. Spine,1999,24(10):1023-1028.
[3] Ntoukas V,Müller A. Minimally invasive approach versus tradi-tional open approach for one level posterior lumbar interbody fu-sion[J]. Minim Invasive Neurosurg,2010,53(1):21-24.
[4] Adogwa O,Parker SL,Bydon A,et al. Comparative effective-ness of minimally invasive versus open transforaminal lumbar-interbody fusion:2-year assessment of narcoticuse, return towork,disability,and quality of life[J]. J Spinal Disord Tech,2011,24(8):479-484.
[5]张伟彬,陈扬,杨欣建,等.经椎间孔腰椎椎间融合术与PLIF治疗单节段腰椎间盘突出症的临床疗效比较[J].中国骨与关节损伤杂志,2016,31(1):13-15.
[6]邹海波,绳厚福,李中实,等. TLIF单侧或双侧固定治疗腰椎退行性疾病的临床疗效[J].中国脊柱脊髓杂志,2013,23(12):1086-1091.
[7]顾叶,徐耀增,耿德春,等. Coflex与PLIF治疗腰椎退行性疾患的对比研究[J].实用骨科杂志,2014,20(2):97-101.
[8]冯强,周誉.脊柱测量尺和Spinal Mouse脊柱测量仪测量胸椎后凸角、腰椎前凸角的信度和效度[J].中国运动医学杂志,2017,36(2):150-155.
[9]李卫东,崔志明,徐冠华,等. Mast Quadtrant可扩张管通道手术系统治疗腰椎管狭窄症[J].脊柱外科杂志,2010,8(8):207-210.
[10] Ringel F,Stoffel M,Stuer C,et al. Minimally invasive trans-muscular pedicle screw fixation of the thoracic an lunbar spine[J]. Neurosurgery,2006,59(4):S361-366,367.
[11]戈浩,吕建军. PLIF与TLIF治疗老年退变性腰椎滑脱合并腰椎管狭窄症的疗效比较[J].湖南师范大学学报(医学版),2016,13(6):41-44.
[12]郭德立,刘欣,李涛,等. TLIF与PLIF对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效[J].现代生物医学进展,2017,16(32):3125-3128.
[13]田伟,李加宁,韩骁,等. TLIF与PLIF治疗老年退变性腰椎滑脱并椎管狭窄症的比较[J].中国矫形外科杂志,2017,25(17):1537-1540.