改良椎板截骨回植与传统椎板截骨回植治疗腰椎间盘突出症合并腰椎不稳的疗效比较
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摘要
目的:评价改良椎板截骨回植与传统椎板截骨回植治疗腰椎间盘突出症合并腰椎不稳的临床疗效。方法:对2008年3月至2013年3月手术治疗的146例单侧腰椎间盘突出症合并腰椎失稳患者的临床资料进行分析,其中传统椎板截骨回植组(传统组)77例,男42例,女35例,年龄(49.4±18.5)岁,突出节段L_(4,5)46例,L_5S_1 31例;改良椎板截骨回植组(改良组)69例,男37例,女32例,年龄(49.8±17.9)岁;突出节段L_(4,5)40例,L_5S_1 29例。对两组患者的手术时间、术中出血量、术中神经及硬膜囊损伤率、术后椎板愈合率及腰腿痛复发率进行比较;并采用视觉模拟量表(VAS)评分及日本骨科协会(JOA)评分评价两组患者的临床疗效。结果:两组患者在手术时间、术中出血量上的差异无统计学意义。改良组神经损伤率和硬膜囊损伤率分别为5.80%(4/69)和1.45%(1/69),传统组分别为16.9%(13/77)和9.09%(7/77),两组比较差异有统计学意义(P<0.05);3年椎间融合率和腰痛复发率改良组分别为91.3%(63/69)、8.70%(6/69),传统组分别为76.62%(59/77)、29.9%(23/77),两组比较差异有统计学意义。术后6个月,1、2、3年VAS评分较术前降低,而JOA评分均较术前升高(P<0.05)。术后1、2、3年改良组VAS评分均小于传统组(P<0.05),而JOA评分均大于传统组(P<0.05)。结论:改良椎板截骨回植在改善腰椎间盘突出症合并腰椎不稳的长期疗效(3年腰痛复发率、椎间融合率、VAS评分及JOA评分)方面优于目前传统椎板截骨回植术。
Objective:To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability. Methods:The clinical data of 146 patients with unilateral lumbar disc herniation with lumbar instability underwent surgical treatment from March 2008 to March2013 were retrospectively analyzed. Patients were divided into two groups according to osteotomy replantation pattern. There were 77 patients in the traditional group(underwent traditional lamina osteotomy replantation),including 42 males and 35 females with an average age of(49.4±18.5) years;the lesions occurred on L_(4,5) in 46 cases,on L_5S_1 in 31 cases. There were 69 patients in modified group(underwent modified lamina osteotomy replantation),including 37 males and 32 females with an average age of(49.8±17.9) years;the lesions occurred on L_(4,5) in 40 cases,on L_5S_1 in 29 cases. The operation time,intraoperative blood loss,complication rate during operation,lamina healing rate,recurrence rate of low back and leg pain were compared between two groups. Visual analogue scales(VAS) and Japanese Orthopadic Association(JOA) scores were used to evaluate the clinical effects. Results:The operation time and intraoperative blood loss were similar between two group(P>0.05). There was significantly different in nerve injury rate(5.80% vs 16.9%) and dural injury rate(1.45% vs 9.09%) between modified group and traditional group(P<0.05). The recurrent rate of low back pain of modified group was higher(91.30%,63/69) than that of traditional group(76.62%,59/77),and the intervertebral fusion rate of modified group was lower(8.70%,6/69) than that of traditional group(29.9%,23/77) at 3 years after operation. Postoperative VAS scores of all patients were significantly decreased at 6 months,1,2,3 years,and JOA scores were obviously increased(P<0.05). At 1,2,3 years after operation,VAS scores of modified group were significantly lower than that of traditional group(P<0.05),and JOA scores of modified group were higher than that of traditional group(P<0.05). Conclusion:Modified lamina osteotomy replantation has better long term efficacy(in the aspect of recurrent rate of low back pain,intervertebral fusion rate,VAS and JOA score at three years follow up) in treating lumbar disc herniation with instability.
Objective:To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability. Methods:The clinical data of 146 patients with unilateral lumbar disc herniation with lumbar instability underwent surgical treatment from March 2008 to March2013 were retrospectively analyzed. Patients were divided into two groups according to osteotomy replantation pattern. There were 77 patients in the traditional group(underwent traditional lamina osteotomy replantation),including 42 males and 35 females with an average age of(49.4±18.5) years;the lesions occurred on L_(4,5) in 46 cases,on L_5S_1 in 31 cases. There were 69 patients in modified group(underwent modified lamina osteotomy replantation),including 37 males and 32 females with an average age of(49.8±17.9) years;the lesions occurred on L_(4,5) in 40 cases,on L_5S_1 in 29 cases. The operation time,intraoperative blood loss,complication rate during operation,lamina healing rate,recurrence rate of low back and leg pain were compared between two groups. Visual analogue scales(VAS) and Japanese Orthopadic Association(JOA) scores were used to evaluate the clinical effects. Results:The operation time and intraoperative blood loss were similar between two group(P>0.05). There was significantly different in nerve injury rate(5.80% vs 16.9%) and dural injury rate(1.45% vs 9.09%) between modified group and traditional group(P<0.05). The recurrent rate of low back pain of modified group was higher(91.30%,63/69) than that of traditional group(76.62%,59/77),and the intervertebral fusion rate of modified group was lower(8.70%,6/69) than that of traditional group(29.9%,23/77) at 3 years after operation. Postoperative VAS scores of all patients were significantly decreased at 6 months,1,2,3 years,and JOA scores were obviously increased(P<0.05). At 1,2,3 years after operation,VAS scores of modified group were significantly lower than that of traditional group(P<0.05),and JOA scores of modified group were higher than that of traditional group(P<0.05). Conclusion:Modified lamina osteotomy replantation has better long term efficacy(in the aspect of recurrent rate of low back pain,intervertebral fusion rate,VAS and JOA score at three years follow up) in treating lumbar disc herniation with instability.
引文
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[4]傅晨,张功林,杨成勇,等.内固定加植骨融合治疗腰椎间盘突出合并腰椎失稳[J].中国骨伤,2009,22(10):755-756.FU C,ZHANG GL,YANG CY,et al.Treatment of lumbar intervertebral disc herniation accompanying with lumbar instability with internal fixation and spinal fusion[J].Zhongguo Gu Shang/China J Orthop Trauma,2009,23(10):755-756.Chinese with abstract in English.
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[10]Busic Z,Kostic S,Kosta V,et al.Postlaminectomy stabilization of the spine in a rat model of neuropathic pain reduces pain related behavior[J].Spine(Phila Pa 1976),2012,37(22):1874-1882.
[11]Xu HH,Wang XQ,Zhang YL,et al.Efficacy evaluation for the treatment of unstable lumbar disc herniation by traditional and modified lamina osteotomy replantation[J].Chin Med J(Engl),2013,126(15):2840-2845.
[12]Nagashima M,Abe H,Amaya K,et al.Risk factors for lumbar disc degeneration in high school American football players:a prospective 2 year follow up study[J].Am J Sports Med,2013,41(9):2059-2064.
[13]Adachi K,Futami T,Ebihara A,et al.Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis[J].Spine J,2003,3(6):471-478.
[14]Nong L,Zhou D,Xu N,et al.Lamina replacement with titanium plate fixation improves spinal stability after total lumbar laminectomy[J].Comput Methods Biomech Biomed Engin,2015,18(16):1753-1759.
[15]靳安民,姚伟涛,张辉.腰椎间盘突出症术后疗效不佳的原因分析及对策[J].中华骨科杂志,2003,23(11):657-660.JIN AM,YAO WT,ZHANG H.Analysis and strategy on the less approved results of lumbar discectomy[J].Zhonghua Gu Ke Za Zhi,2003,23(11):657-660.Chinese.
[16]武宜亮,李建江,黄异飞,等.几丁糖和聚乳酸防粘连凝胶及玻璃酸钠预防硬膜外瘢痕粘连的实验研究[J].浙江中西医结合杂志,2010,20(3):141-145.WU YL,LI JJ,HUANG YF,et al.An experimental study on prevention of postlaminectomy adhesion by the use of chitosan,polyactic acid glue,and sodium hyaluronate[J].Zhe Jiang Zhong Xi Yi Jie He Za Zhi,2010,20(3):141-145.Chinese.
[17]Demondion X,Vidal C,Glaude E,et al.The posterior lumbar ramus:CT anatomic correlation and propositions of new sites of infiltration[J].AJNR Am J Neuroradiol,2005,26(4):706-710.
[18]Lien SB,Liou NH,Wu SS.Analysis of anatomic morphometry of the pedicles and the safe zone for through pedicle procedures in the thoracic and lumbar spine[J].Eur Spine J,2007,16(8):1215-1222.
[2]贾连顺.脊柱外科学[M].上海:第二军医大学出版社,2009:220-230.JIA LS.Spinal Surgery[M].Shanghai:The Second Military Medical University Press,2009:220-230.Chinese.
[3]林勇,赵永生,历强,等.全椎板切除后椎板重建治疗腰椎管狭窄症[J].中国骨伤,2010,23(7):511-513.LIN Y,ZHAO YS,LI Q,et al.Clinical analysis of vertebral laminae reconstruction after laminectomy and pedicle screw fixation in treating lumbar spinal stenosis[J].Zhongguo Gu Shang/China J Orthop Trauma,2010,23(7):511-513.Chinese with abstract in English.
[4]傅晨,张功林,杨成勇,等.内固定加植骨融合治疗腰椎间盘突出合并腰椎失稳[J].中国骨伤,2009,22(10):755-756.FU C,ZHANG GL,YANG CY,et al.Treatment of lumbar intervertebral disc herniation accompanying with lumbar instability with internal fixation and spinal fusion[J].Zhongguo Gu Shang/China J Orthop Trauma,2009,23(10):755-756.Chinese with abstract in English.
[5]Epstein NE.A preliminary study of the efficacy of Beta Tricalcium Phosphate as a bone expander for instrumented posterolateral lumbar fusions[J].J Spinal Disord Tech,2006,19(6):424-429.
[6]Overdevest GM,Jacobs W,Vleggeert Lankamp C,et al.Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis[J].Cochrane Database Syst Rev,2015,(3):CD010036
[7]郑燕平,李伟,刘新宇,等.腰椎椎板截骨原位回植术的远期疗效分析[C].第3届中西医结合脊柱及相关疾病学术年会论文集,2009.ZHENG YP,LI W,LIU XY,et al.Long-term effect of the treatment for lumbar intervertebral disc herniation with total laminectomy and replantation[C].Proceedings of Third Annual Conference of Chinese Medicine and Western Medicine in Spine and Related Diseases,2009.Chinese.
[8]Tai CL,Hsieh PH,Chen WP,et al.Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome an experimental study in porcine model[J].BMC Musculoskelet Disord,2008,9(1):84.
[9]Yücesoy K,Crawford NR.Increase in spinal canal area after inverse laminoplasty:an anatomical study[J].Spine(Phila Pa 1976),2000,25(21):2771-2776.
[10]Busic Z,Kostic S,Kosta V,et al.Postlaminectomy stabilization of the spine in a rat model of neuropathic pain reduces pain related behavior[J].Spine(Phila Pa 1976),2012,37(22):1874-1882.
[11]Xu HH,Wang XQ,Zhang YL,et al.Efficacy evaluation for the treatment of unstable lumbar disc herniation by traditional and modified lamina osteotomy replantation[J].Chin Med J(Engl),2013,126(15):2840-2845.
[12]Nagashima M,Abe H,Amaya K,et al.Risk factors for lumbar disc degeneration in high school American football players:a prospective 2 year follow up study[J].Am J Sports Med,2013,41(9):2059-2064.
[13]Adachi K,Futami T,Ebihara A,et al.Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis[J].Spine J,2003,3(6):471-478.
[14]Nong L,Zhou D,Xu N,et al.Lamina replacement with titanium plate fixation improves spinal stability after total lumbar laminectomy[J].Comput Methods Biomech Biomed Engin,2015,18(16):1753-1759.
[15]靳安民,姚伟涛,张辉.腰椎间盘突出症术后疗效不佳的原因分析及对策[J].中华骨科杂志,2003,23(11):657-660.JIN AM,YAO WT,ZHANG H.Analysis and strategy on the less approved results of lumbar discectomy[J].Zhonghua Gu Ke Za Zhi,2003,23(11):657-660.Chinese.
[16]武宜亮,李建江,黄异飞,等.几丁糖和聚乳酸防粘连凝胶及玻璃酸钠预防硬膜外瘢痕粘连的实验研究[J].浙江中西医结合杂志,2010,20(3):141-145.WU YL,LI JJ,HUANG YF,et al.An experimental study on prevention of postlaminectomy adhesion by the use of chitosan,polyactic acid glue,and sodium hyaluronate[J].Zhe Jiang Zhong Xi Yi Jie He Za Zhi,2010,20(3):141-145.Chinese.
[17]Demondion X,Vidal C,Glaude E,et al.The posterior lumbar ramus:CT anatomic correlation and propositions of new sites of infiltration[J].AJNR Am J Neuroradiol,2005,26(4):706-710.
[18]Lien SB,Liou NH,Wu SS.Analysis of anatomic morphometry of the pedicles and the safe zone for through pedicle procedures in the thoracic and lumbar spine[J].Eur Spine J,2007,16(8):1215-1222.