小切口下膨胀性椎间融合器在复发性腰椎间盘突出症中的应用

Application of expandable intervertebral cage in treating recurrent lumbar intervertebral disc via posterior mini-incision

中文关键词:  腰椎间盘突出症  复发性  微创性  脊柱融合术  腰椎曲度

英文关键词:Lumbar disc herniation  Recurrent  Minimally invasive  Spine fusion  Lumbar instability

中文摘要:

  【摘要】 目的：评价后路小切口下应用膨胀性椎间融合器行腰椎融合术治疗复发性腰椎间盘突出症的临床疗效。方法：回顾性分析2010年5月~2014年3月确诊为复发性腰椎间盘突出症的患者资料，将采用膨胀性融合器行腰椎融合术的病例归为A组，共28例；将采用椎弓根内固定系统行腰椎融合术的病例归为B组，共29例。采用日本矫形外科协会（JOA）腰痛评分标准评定临床疗效；采用视觉模拟评分法（VAS）评价患肢疼痛的改善情况；采用腰椎前凸角评价手术节段腰前凸的变化；椎间植骨融合按照Suk标准判定，同时观察过伸过屈位时置入物的稳定性。所有数据进行统计学处理分析。结果：A组切口长度4.1±0.4cm、手术时间73.0±28.6min、出血量159.0±50.4ml、引流量180±88.6ml、住院时间7.5±1.2d；B组切口长度12.3±1.6cm、手术时间131.0±26.8min、出血量358.0±46.7ml、引流量360±78.6ml、住院时间16.6±1.5d，两组手术时间、切口长度、出血量、引流量、住院时间差异均有显著性（P<0.05），A组明显低于B组。两组随访时间均为12～26个月，A组平均12.9±7.8个月，B组平均13.7±6.9个月，两组对比无显著性差异（P>0.05）。并发症：A组3例出现脑脊液漏，B组2例出现脑脊液漏，两组均无感染、神经根损伤及内置物松动、移位等并发症。末次随访时两组椎间植骨均获得融合或可能融合。末次随访时，A组JOA评分由术前的4.52±1.87分提高为12.57±2.95分、改善率（76.81±7.2）%，VAS评分由术前的4.45±1.66分降为1.92±0.64分，腰椎手术节段前凸角由术前的16.82°±1.78°变为21.9°±1.59°；B组JOA评分由术前的4.71±1.62分提高为12.31±2.86分、改善率（73.86±8.6）%，VAS评分由术前的4.68±1.13分降为2.13±1.92分，腰椎手术节段前凸角由术前的17.33°±2.61°变为15.9°±3.26°。两组间JOA评分、改善率及VAS评分同时间点对比差异无显著性（P>0.05），两组间腰椎手术节段前凸角术前对比无显著差异性（P>0.05）、末次随访时对比存在显著差异性（P<0.05）。结论：后路小切口下应用膨胀性融合器行腰椎融合术治疗复发性腰椎间盘突出症，具有与应用椎弓根内固定系统一样的临床疗效和融合效果，同时具有创伤小、住院时间短、能够维持腰椎曲度的优点。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effect of expandable intervertebral cage via posterior mini-incision for recurrent lumbar disc herniation. Methods: Retrospective analysis on patients with recurrent lumbar disc herniation from March 2014 to May 2010 was performed. In group A, 28 cases were treated with the expansion of fusion cage. Group B included 29 cases undergoing pedicle internal fixation system for lumbar interbody fusion. The Japanese Orthopedic Association(JOA) score was used to assess clinical outcome; visual analog scale(VAS) was used to evaluate low back pain; The segmental lumbar lordosis angle change was also evaluated. Postoperative lumbar X-ray and dynamic X-ray film was used to evaluate intervertebral bone graft fusion. According to the standard of Suk judgment, the cage stability was evaluated under the hyper extension and flexion position. All data were statistically analyzed. Results: In group A, the operation time was 73.0±28.6min, the length of incision was 4.1±0.4cm, the bleeding volume was 159.0±50.4ml, the drainage was 180±88.6ml, the hospitalization time was 7.5±1.2d; while in group B, the operation time was 131.0±26.8min, the length of incision was 12.3±1.6cm, the bleeding volume was 358.0±46.7ml, the drainage was 360±78.6ml, the hospitalization time was 16.6±1.5d. There were significant differences in operation time, incision length, bleeding volume, drainage volume and hospitalization time between the two groups. Follow-up time ranged from 12 to 26 months, with an average of 13.8±6.9 months. There were 3 cases in group A and 2 cases in group B suffering from cerebrospinal fluid leakage. No infection, nerve injury and instrument failure were noted. At final follow-up, bony fusion were obtained in 2 groups.In group A, JOA scores increased from 4.52±1.87 points preoperatively to 12.57±2.95 points postoperatively, with an improvement rate of (76.81±7.2)%, VAS score decreased from 4.45±1.66 points preoperatively to 1.92±0.64 points, segmental lordosis angle increased from 16.82°±1.78° preoperatively to 21.9°±1.59°; in group B, JOA scores increased from 4.71±1.62 points preoperatively to 12.31±2.86 points, with the improvement rate of (73.86±8.6)%, VAS score decreased from 4.68±1.13 points preoperatively to 2.13±1.92 points, segmental lordosis angle decreased from 17.33°±2.61° preoperatively to 15.9°±3.26°. Conclusions: The application of the expansive fusion device for recurrent lumbar disc herniation has good clinical effect, and has the advantages of less invasion, shorter hospitalization time and well maintaining of the lumbar curvature.