经中线皮质骨螺钉固定椎间融合术治疗腰椎退行性疾病的中期疗效分析

Mid-term efficacy of midline lumbar interbody fusion in the treatment of lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  经中线腰椎融合术  皮质骨螺钉  疗效  适应证

英文关键词:Lumbar degenerative disease  Midline lumbar interbody fusion  Cortical bone trajectory  Outcomes  Indications

中文摘要:

  【摘要】 目的：对比分析经中线皮质骨螺钉固定椎间融合术（midline lumbar interbody fusion，MIDLIF）和传统后路椎弓根螺钉固定椎间融合术（posterior lumbar interbody fusion，PLIF）治疗腰椎退变性疾病患者的中期疗效。方法：回顾性分析2017年2月～2018年4月我院行腰椎后路植骨融合内固定术治疗并随访的93例腰椎退变性疾病患者的临床资料，其中采用皮质骨螺钉（cortical bone trajectory，CBT）固定45例（CBT组），传统椎弓根螺钉（pedicle screw，PS）固定48例（PS组）。术后1个月及末次随访时应用视觉模拟评分法（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）及日本骨科学会（Japanese Orthopaedic Association，JOA）腰痛评分进行疗效评价；通过腰椎正侧位X线片及CT扫描评估椎间融合情况，测量手术前后及末次随访时融合节段椎间高度、椎间孔高度、椎间孔面积及前凸角，采用改良MacNab量表评估最终疗效，通过患者主观感受评价满意度。结果：CBT组平均随访52.56±4.52个月，PS组平均随访52.08±3.92个月。两组患者在年龄、性别比例、疾病类别组成、手术节段构成比、术前腰腿痛VAS评分、ODI及JOA评分均无统计学差异（P>0.05）。两组患者术前手术节段椎间高度、椎间孔高度、椎间孔面积及节段前凸角无显著性差异（P>0.05）。两组患者术后1个月、末次随访腰痛和下肢痛VAS评分、ODI及JOA评分与术前比较差异均具有统计学意义（P<0.05）；术后1个月、末次随访时手术节段椎间高度、椎间孔高度、椎间孔面积及节段前凸角较术前增加（P<0.05）；术后1个月、末次随访时两组间相应随访时间点各指标对比均无统计学意义（P＞0.05）。末次随访时患者均达到骨性融合；93例患者共出现9例并发症；CBT组3例（6.7%），其中螺钉松动并融合装置移位1例；下位椎弓峡部骨折1例；1例出现邻近节段退变，无翻修病例；PS组6例（12.5%），其中伤口感染不愈合1例，螺钉松动2例，3例出现邻近节段退变，1例为症状性ASD行翻修手术；两组无椎弓根骨折、关节突干扰等其他并发症；两组总体并发症发生率无统计学差异（P>0.05）。末次随访时，两组MacNab优良率分别为82.22%和79.17%（P>0.05）；患者满意度分别为95.6%和93.8%（P>0.05）。结论：在腰椎退行性疾病的外科治疗中，采用MIDLIF技术能够获得与PLIF技术一致的临床疗效且中期随访结果满意。

英文摘要:

  【Abstract】 Objectives: To compare and analyze the medium outcomes of midline lumbar interbody fusion(MIDLIF) with cortical bone trajectory(CBT) screw and posterior lumbar interbody fusion(PLIF) with pedicle screw(PS) in treating patients with lumbar degenerative diseases. Methods: 93 patients with lumbar degenerative diseases who underwent posterior lumbar decompression fusion surgery between February 2017 and April 2018 and finished time-point follow-up were reviewed. There were 45 cases in CBT group and 48 cases in PS group. The clinical outcomes were evaluated by visual analogue scale(VAS), Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) Scores at 1 month after surgery and final follow-up. Antero-posterior and lateral X-rays and CT scans were performed to estimate the interbody fusion conditions, and the disc height, foraminal height, foraminal area and segmental lordosis of operated segments were measured before operation and at final follow-up. The modified MacNab scale was used for evaluating the ultimate outcomes, and the patient satisfaction was assessed through subjective feelings. Results: CBT group and PS group were followed up for 52.56±4.52 months and 52.08±3.92 months respectively. There were no statistically significant differences in age, sex, surgical level, preoperative VAS score of low back pain and leg pain, the ODI and JOA score between the two groups(P>0.05). The disc height, foraminal height, foraminal area and segmental lordosis of operated segement before surgery of the two groups were not significantly different from each other(P>0.05). Compared with pre-operation, the postoperative 1 month and final follow-up VAS scores of low back and leg pain, ODI, and JOA scores of both groups were statistically different(P<0.05); the postoperative 1 month and final follow-up disc height, foraminal height, foraminal area, and segmental lordosis of operated segments all increased(P<0.05); there was no statistical difference in corresponding indicators at postoperative 1 month and final follow-up between the two groups(P>0.05). All patients achieved bony fusion. 9 cases out of 93 occurred complications, including: 3 cases(6.7%) in CBT group, with 1 case of screw loosening and fusion cage dislocation, 1 case of isthmus fracture of the inferior pedicle, and 1 case of adjacent segement degeneration, none underwent re-operation; 6 cases in PS group, with 1 case of wound infection, 2 cases of screw loosening, 3 cases of adjacent segement degeneration, and 1 case of symptomatic ASD underwent re-operation. The overall complication rates between groups were not statistically different(P>0.05). The excellent-good rate of MacNab was 82.22%, and the satisfaction rate was 95.6% in CBT group at final follow-up; the excellent-good rate and satisfaction rate were 79.17% and 93.8% in PS group, and no statistically different between two groups(P>0.05). Conclusions: Comparing with PLIF with PS, MIDLIF can obtain consistently clinical outcomes in the treatment of lumbar degenerative diseases, with satisfactory medium results.