三种腰椎固定融合术式治疗腰椎术后邻椎病的疗效对比分析

Comparative analysis of the clinical efficacies of three surgical methods for the treatment of adjacent segment disease after lumbar fusion

中文关键词:  邻椎病  脊柱融合  手术方式  临床疗效

英文关键词:Adjacent segment disease  Spinal fusion  Surgical method  Clinical effect

中文摘要:

  【摘要】 目的：分析斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）、后路皮质骨轨迹（cortical bone trajectory，CBT）螺钉固定中线腰椎椎间融合术（midline lumbar interbody fusion，MIDLIF）、传统后路腰椎椎间融合术（posterior lumbar interbody fusion，PLIF）治疗腰椎融合术后邻椎病的临床疗效。方法：回顾性分析2013年5月~2020年9月收治的60例腰椎融合术后邻椎病患者的临床资料，男31例，女29例；年龄40~73岁（57.4±13.8岁），距首次融合固定术6~84个月（56.3±20.8个月）。融合邻近节段腰椎间盘突出26例，腰椎管狭窄23例，腰椎滑脱不稳11例。依据不同术式分为OLIF组16例、MIDLIF组20例和PLIF组24例。记录3组患者手术时间、术中出血量、住院时间及围手术期情况。应用视觉模拟量表（visual analogue scale，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI）评定术前、术后3个月和末次随访时的腰腿痛和腰椎功能情况，在术前、术后3个月的腰椎正侧位X线片上测量邻椎病手术节段椎间隙高度（interbody disc height，IDH）、椎间孔高度（interbody foraminal height，IFH）及椎间孔面积（interbody foraminal area，IFA）。结果：3组患者年龄、性别、病变节段、术前VAS评分和ODI均无统计学差异（P>0.05）。OLIF组术中出血量、手术时间、住院时间分别为125.6±14.5ml、92.3±13.5min、6.3±1.2d，MIDLIF组分别为220.4±15.2ml、120.6±11.4min、10.5±1.4d，PLIF组分别为218.4±12.5ml、115.4±10.7min、10.4±1.4d，OLIF组术中出血量、手术时间、住院时间均较MIDLIF组和PLIF组显著性减少（P<0.05），而MIDLIF组和PLIF组无显著性差异（P>0.05）。随访10~32个月（20.5±5.8个月），OLIF组术后3个月时腰痛、下肢痛VAS评分、ODI分别为2.43±0.52分、2.37±0.63分、（20.47±3.10）%，末次随访时分别为2.10±0.52分、2.05±0.31分、（14.14±2.41）%；MIDLIF组术后3个月时分别为2.84±0.67分、1.93±0.36分、（21.89±3.07）%，末次随访时分别为1.94±0.55分、1.75±0.20分、（15.32±2.11）%；PLIF组术后3个月时分别为3.22±0.82分、2.24±0.42分、（23.51±3.41）%，末次随访时分别为1.83±0.49分、1.92±0.28分、（16.40±2.10）%。3组术后3个月和末次随访时的腰痛VAS评分、下肢痛VAS评分和ODI均较术前[OLIF组7.47±1.03分、7.55±1.04分、（70.63±5.46）%；MIDLIF组7.50±0.99分、7.46±1.10分、（69.89±5.55）%；PLIF组7.51±1.01分、7.53±1.11分、（71.05±5.71）%]显著性改善（P<0.05），3组间同时间点比较均无显著性差异（P>0.05）。OLIF组术后3个月时IDH、IFH、IFA分别为10.47±0.86mm、21.41±2.57mm、210.57±11.34mm2；MIDLIF组分别为9.11±0.79mm、18.70±2.62mm、196.41±13.40mm2；PLIF组分别为9.26±0.91mm、19.37±2.51mm、193.42±12.12mm2。3组患者术后3个月时IDH、IFH、IFA较术前（OLIF组5.86±0.76mm、14.52±2.31mm、135.84±10.41mm2；MIDLIF组5.90±0.69mm、14.43±2.27mm、127.10±10.64mm2；PLIF组5.79±0.81mm、14.39±2.40mm、126.47±10.55mm2）均有显著性改善（P<0.05），三组间同时点比较均无显著性差异（P>0.05）。3组患者围手术期并发症无统计学差异（P>0.05）。结论：OLIF、MIDLIF、PLIF治疗腰椎融合术后邻椎病均可获得满意的临床疗效，但OLIF手术时间和住院时间更短、术中出血量更少。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical effects of oblique lumbar interbody fusion(OLIF), posterior cortical bone trajectory(CBT) screw fixation and midline lumbar interbody fusion(MIDLIF) and traditional posterior lumbar interbody fusion(PLIF) in the treatment of adjacent segment diseases(ASD) after lumbar fusion. Methods: The clinical data of 60 patients with adjacent segment diseases after lumbar fusion treated in our hospital between May 2013 and September 2020 were analyzed retrospectively, including 31 males and 29 females, aged 40-73 years(57.4±13.8 years) old. The interval from the first fusion fixation for all the patients was 6-84 months(56.3±20.8 months). Among them, 26 cases were with adjacent segment lumbar disc herniation, 23 with lumbar spinal canal stenosis, and 11 with lumbar spondylolisthesis and unstable. According to different surgical methods, the patients were divided into OLIF group(n=16), MDLIF group(n=20), and PLIF group(n=24). The operation time, intraoperative blood loss, hospital stay, and perioperative conditions of the three groups of patients were recorded. The visual analogue scale(VAS) and the Oswestry disability index(ODI) were used to evaluate low back and leg pain and lumbar function at preoperation, 3 months after surgery, and final follow-up. The interbody disc height(IDH), interbody foraminal height(IFH), and interbody foraminal area(IFA) were measured on anteroposterior lateral X-ray of the lumbar spine at preoperation and 3 months after surgery. Results: There were no statistically significant differences in age, gender, lesion segment, preoperative VAS score and ODI among the three groups of patients(P>0.05). The intraoperative blood loss, operation time, and hospital stay were 125.6±14.5ml, 92.3±13.5min, and 6.3±1.2d in OLIF group, 220.4±15.2ml, 120.6±11.4min, and 10.5±1.4d in MIDLIF group, and 218.4±12.5ml, 115.4±10.7min, and 10.4±1.4d in PLIF group. The intraoperative blood loss, operation time, and hospital stay of OLIF group were significantly lower than those in MIDLIF group and PLIF group(P<0.05), while there was no significant difference between those of MIDLIF group and PLIF group(P>0.05). The patients were followed up for 10-32 months(20.5±5.8 months). In the OLIF group, the VAS scores of low back pain and lower limb pain and ODI were 2.43±0.52, 2.37±0.63 and (20.47±3.10)% at 3 months after operation, and 2.10±0.52, 2.05±0.31and (14.14±2.41)% at the final follow-up; In the MIDLIF group, those parameters were 2.84±0.67, 1.93±0.36 and (21.89±3.07)% at 3 months after operation, and 1.94±0.55, 1.75±0.20 and (15.32±2.11)% at the final follow-up; In the PLIF group, those were 3.22±0.82, 2.24±0.42 and (23.51±3.41)% at 3 months after operation, and 1.83±0.49, 1.92±0.28 and (16.40±2.10)% at the final follow-up. The low back pain and lower limb pain VAS scores and ODI at 3 months postoperatively and final follow-up of the three groups significantly improved than those before operation[OLIF group, 7.47±1.03, 7.55±1.04 and (70.63±5.46)%; MIDLIF group, 7.50±0.99, 7.46±1.10 and (69.89±5.55)%; PLIF group, 7.51±1.01, 7.53±1.11 and (71.05±5.71)%](P<0.05), while there was no significant difference between the three groups at the same time point(P>0.05). At 3 months after operation, the IDH, IFH, and IFA were respectively 10.47±0.86mm, 21.41±2.57mm, 210.57±11.34mm2 in OLIF group; 9.11±0.79mm, 18.70±2.62mm, and 196.41±13.40mm2 in MIDLIF group; and 9.26±0.91mm, 19.37±2.51mm, 193.42±12.12mm2 in PLIF group. The IDH, IFH, and IFA of the three groups at three months after operation significantly improved compared with those before operation(OLIF group, 5.86±0.76mm, 14.52±2.31mm, and 135.84±10.41mm2; MIDLIF group, 5.90±0.69mm, 14.43±2.27mm, and 127.10±10.64mm2; PLIF group, 5.79±0.81mm, 14.39±2.40mm, and 126.47±10.55mm2)(P<0.05), while there was no statistical significance between the three groups at the same time point(P>0.05). There was no significant difference in perioperative complications among the three groups(P>0.05). Conclusions: OLIF, MIDLIF, and PLIF all achieved satisfactory clinical effects in the treatment of adjacent segment diseases after lumbar fusion surgery, while the operation time and hospital stay of OLIF were shorter and the intraoperative bleeding was less.