椎间盘镜下单侧开窗双侧减压椎体间融合术对腰椎管狭窄症患者疼痛及脊柱功能的影响
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摘要
目的了解复杂腰椎管狭窄症患者行椎间盘镜(Micro Endo Disc System,MED)下单侧开窗双侧减压椎体间融合术对脊柱功能及疼痛情况的影响。方法选取我院2014-02-2015-02需行MED下单侧开窗双侧减压椎体间融合术的腰椎管狭窄症患者64例作为研究对象,了解患者术前术后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数问卷表(ODI)及术后影像学脊柱情况。结果 64例患者均未发生神经损伤,在术后影像学检查中,正侧位X线片内未见植物断裂或松动,内固定位置良好,脊柱序列得到改善,减压充分。术后3个月与末次随访时患者ODI、VAS腰痛、VAS腿痛评分均显著低于术前,差异有统计学意义(F=255.72,F=582.38,F=3007.58,P<0.05)。术后3个月与末次随访时患者椎间隙高度、Cobb角、滑脱比均显著低于术前,差异有统计学意义(F=6.53,F=18.01,F=5.28,P<0.05)。结论复杂腰椎管狭窄症患者行MED下单侧开窗双侧减压椎体间融合术可有效缓解患者临床症状,减轻疼痛程度,改善脊柱功能,术后疗效较好。
Objective To investigate the effect of unilateral fenestration and bilateral decompression interbody fusion under MED(diskoscope)on pain and spinal function in patients with lumbar spinal stenosis. Methods From February 2014 to February 2015, 64 patients of lumbar spinal stenosis with unilateral fenestration and bilateral decompression interbody fusion under MED in our hospital were selected in the research. The preoperative and postoperative visual analogue scale(VAS),Oswestry disability index(ODI)questionnaire and postoperative spine imaging condition were investigated. Results There were no nerve injuries in 64 cases. The postoperative imaging examination showed that no implant rupture or loosening in positive X-ray film,the internal fixation location was good, the spine sequence was improved and the decompression was sufficient. The ODI, VAS backache,VAS leg pain scores at 3 months after operation and the last follow-up were significantly lower than before surgery,the differences were statistically significant(F =255.72,F =582.38,F =3007.58,P<0.05). At 3 months after operation and the last follow-up,the height of the intervertebral space,Cobb angle and the ratio of spondylolisthesis were significantly lower than before operation,the differences were statistically significant(F=6.53,F=18.01,F=5.28,P<0.05). Conclusion Unilateral fenestration and bilateral decompression interbody fusion under MED adopted for patients with lumbar spinal stenosis can effectively alleviate the clinical symptoms and pain,improve the spinal function simultaneously with impressive postoperative curative effect.
Objective To investigate the effect of unilateral fenestration and bilateral decompression interbody fusion under MED(diskoscope)on pain and spinal function in patients with lumbar spinal stenosis. Methods From February 2014 to February 2015, 64 patients of lumbar spinal stenosis with unilateral fenestration and bilateral decompression interbody fusion under MED in our hospital were selected in the research. The preoperative and postoperative visual analogue scale(VAS),Oswestry disability index(ODI)questionnaire and postoperative spine imaging condition were investigated. Results There were no nerve injuries in 64 cases. The postoperative imaging examination showed that no implant rupture or loosening in positive X-ray film,the internal fixation location was good, the spine sequence was improved and the decompression was sufficient. The ODI, VAS backache,VAS leg pain scores at 3 months after operation and the last follow-up were significantly lower than before surgery,the differences were statistically significant(F =255.72,F =582.38,F =3007.58,P<0.05). At 3 months after operation and the last follow-up,the height of the intervertebral space,Cobb angle and the ratio of spondylolisthesis were significantly lower than before operation,the differences were statistically significant(F=6.53,F=18.01,F=5.28,P<0.05). Conclusion Unilateral fenestration and bilateral decompression interbody fusion under MED adopted for patients with lumbar spinal stenosis can effectively alleviate the clinical symptoms and pain,improve the spinal function simultaneously with impressive postoperative curative effect.
引文
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[8]罗辉耀,苗立冬,吴昊.双侧开窗减压钉棒固定椎间融合治疗峡部裂腰椎滑脱症[J].颈腰痛杂志,2017,38(1):81-83.
[2]文天林,刘秀梅,杜培,等.Quadrant微创通道下单侧开窗减压与开放减压内固定术治疗退变性腰椎管狭窄症病例对照研究[J].中国骨伤,2014,27(8):658-662.
[3]陈志文,刘晖,丁真奇,等.微创单侧固定与开放双侧固定治疗单间隙腰椎管狭窄症的疗效比效[J].临床骨科杂志,2016,19(2):160-163.
[4]杨圣,芦健民,赵德伟,等.显微外科手术单侧入路双侧减压治疗腰椎管狭窄症[J].中华显微外科杂志,2011,34(3):179-181.
[5]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.
[6]易红蕾,朱晓东,张伟,等.椎板开窗减压Coflex动态固定治疗中度腰椎管狭窄症的疗效评价[J].中国脊柱脊髓杂志,2010,20(10):834-838.
[7]邓必权,胡华,滕宇,等.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症[J].中国临床研究,2017,30(3):306-309.
[8]罗辉耀,苗立冬,吴昊.双侧开窗减压钉棒固定椎间融合治疗峡部裂腰椎滑脱症[J].颈腰痛杂志,2017,38(1):81-83.