IntraSPINE非融合技术联合TLIF治疗双节段腰椎退行性疾病的早期临床疗效

Early clinical efficacy of IntraSPINE non-fusion technique hybrid operation with transforaminal lumbar interbody fusion in the treatment of double-segment lumbar degenerative disease

中文关键词:  腰椎退行性疾病  IntraSPINE  经椎间孔腰椎椎体间融合术  邻近节段退变

英文关键词:Lumbar degenerative disease  IntraSPINE  Transforaminal lumbar interbody fusion  Adjacent segment degeneration

中文摘要:

  【摘要】 目的：探讨IntraSPINE非融合技术联合经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion，TLIF）治疗双节段腰椎退行性疾病（lumbar degenerative disease，LDD）的早期临床疗效。方法：回顾性分析2019年9月~2021年5月我院采用IntraSPINE非融合技术联合TLIF手术和单纯TLIF手术治疗的双节段LDD患者74例。根据手术方式的不同分为观察组（行IntraSPINE非融合技术联合TLIF手术，n=36）和对照组（行TLIF手术，n=38）。两组患者性别、年龄、随访时间差异无统计学意义（P＞0.05）。记录两组患者术前、术后3个月、术后6个月及末次随访时腰部及下肢疼痛视觉模拟评分（visual analogue scale，VAS）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分、Oswestry功能障碍指数（Oswestry disability index，ODI），并在两组患者术前、术后3个月、术后6个月及末随次访时的腰椎侧位X线片上测量腰椎前凸角（lumbar lordosis，LL）、融合节段的上位邻近节段的椎间活动度（range of motion，ROM）和椎间隙高度，在两组患者术前和末次随访时的腰椎MRI上记录融合节段的上位邻近节段的椎间盘Pfirrmann分级，并记录两组患者随访过程中并发症情况。结果：两组患者手术时间、术中出血量和住院时间差异无统计学意义（P＞0.05）。两组患者术后3个月、术后6个月及末次随访时下肢VAS评分、JOA评分、ODI均较术前明显改善（P＜0.05），相同时间点组间比较差异无统计学意义（P＞0.05）；两组腰痛VAS评分较术前明显改善（P＜0.05），观察组术后3个月、6个月和末次随访腰痛VAS评分较对照组改善更为明显（P＜0.05）。两组术后的LL较术前明显改善（P＜0.05），相同时间点组间比较差异无统计学意义（P＞0.05）。末次随访时，观察组融合节段的上位邻近节段椎间隙高度较术前有所增加（P＜0.05），对照组较术前有所降低（P＜0.05）；观察组融合节段的上位邻近节段椎间活动度较术前差异无统计学意义（P＞0.05），对照组较术前有所增加（P＜0.05）。两组末次随访时融合节段的上位邻近节段的椎间盘Pfirrmann分级差异有统计学意义（P＜0.05）。随访过程中两组患者均未出现神经损伤、硬膜撕裂、断钉断棒和融合器移位等严重并发症。结论：IntraSPINE非融合技术联合TLIF治疗双节段LDD能够获得满意的早期临床疗效，腰痛改善程度明显优于单纯TLIF手术，早期可以延缓邻近节段退变的发生。

英文摘要:

  【Abstract】 Objectives: To investigate the early clinical efficacy of the non-fusion technique of IntraSPINE hybrid operation with transforaminal lumbar interbody fusion(TLIF) in the treatment of double-segment lumbar degenerative disease(LDD). Methods: A retrospective analysis was conducted on the clinical data of 74 patients with double-segment LDD who were treated with IntraSPINE technique combined with TLIF and simple TLIF in our hospital from September 2019 to May 2021. The patients were divided according to surgical modalities into observation group(IntraSPINE technique hybrid operation with TLIF, n=36) and control group(TLIF, n=38). There were no statistically significant differences in gender, age, follow-up period between the two groups(P＞0.05). The visual analogue scale(VAS) of back and leg pain, Japanese Orthopaedic Association(JOA) score, Oswestry disability index(ODI) were recorded before surgery, at 3 months and 6 months postoperatively, and final follow-up. At the same time, lumbar lordosis(LL), range of motion(ROM), and height of intervertebral space of the upper adjacent segment of fusion segment were measured on lateral lumbar X-ray films. And Pfirrmann grade of intervertebral disc of the upper adjacent segment of fusion segment on lumbar MRI were recorded before surgery and at final follow-up. The complications were recorded of the two groups. Results: There were no statistically significant differences in operative time, intraoperative blood loss, or length of hospitalization between the two groups(P＞0.05). The VAS scores of leg pain, JOA scores and ODI at 3 months, 6 months after operation and final follow-up were significantly improved in both groups after surgery(P<0.05), and there was no significant difference between groups at the same time point, respectively(P>0.05). The VAS scores of back pain were significantly improved in both groups after surgery(P<0.05), which in the observation group was more significantly improved than that in the control group at 3 and 6 months postoperatively, and final follow-up(P＜0.05). The LL were significantly improved in both groups after surgery(P<0.05), and there was no significant difference between groups at the same time point(P>0.05). At final follow-up, the intervertebral height of the upper adjacent segment of fusion segment was increased after operation in the observation group(P＜0.05), and decreased after operation in the control group(P＜0.05); the ROM of the upper adjacent segment was not statistically different from that before operation in the fusion segment of observation group(P＞0.05), while it was increased after operation in the control group(P＜0.05). There were statistically significant differences in the Pfirrmann grade of intervertebral disc of the upper adjacent segment of the fusion segment between the two groups at final follow-up(P＜0.05). No patients in either group had severe complications, such as nerve root injury, dural tears, internal fixation system fracture, or displacement of the interbody device. Conclusions: IntraSPINE non-fusion technique combined with TLIF can achieve satisfactory early outcomes in the treatment of double-segment LDD, significantly improve low back pain than TLIF, and delay ASD in early stage.