摘要
[目的]探讨腰后路减压植骨融合内固定术治疗腰椎间盘突出症（LDH）患者的中期疗效及邻近节段退变情况。[方法]随访72例因LDH接受腰后路减压椎间融合内固定术治疗的患者，通过对患者术前、末次随访的ODI、L—JOA、VAS评分进行比较，评估患者神经功能恢复情况，以Odom’s标准评估手术优良率。复查X线观察植骨融合率、腰椎指数改善情况及邻近节段活动度。以UCLA标准评价邻近节段退变情况。以Seze法测量腰椎指数。[结果]术后随访3．5～6年，平均57个月；优57例，良8例，可5例，差2例，优良率90．5％，植骨融合率达97．2％。ODI、L-JOA、VAS末次随访评分均显著高于术前（P〈0．05），术后腰椎指数改善明显（P〈0．05），ASD总发生率为23．39％，1．6％的邻近退变节段需再手术处理。多节段组退变率高于单节段组，退变易发于头端节段，术后邻近节段活动度增加，且头端增加率大于尾端（P〈0．05）。[结论]腰后路减压植骨融合内固定术治疗LDH，患者神经功能、生活质量改善明显，植骨融合率较高，中期疗效满意。邻近节段退变明显增加，手术范围、年龄、邻近节段位置、腰椎指数可能影响邻近节段的退变率。
[ Objective] To assess the mid - term clinical outcomes of patients who underwent PLIF due to lumbar disc herniation （LDH）, including the condition of adjacent segment degeneration. [ Methods ] This retrospective study included 72 consecutive patients （40 male and 32 female） . Odom＇ s system, Oswestry Disability Index （ ODI）, lumbar JOA score （ L - JOA） and Visual Analogue Scale （VAS） score were evaluated before surgery and at the follow -up. Routine X -ray radiographs of the lumbar spine were obtained from all patients. Grade of adjacent segments was evaluated by the University of California at Los Angeles Grading Scale system （ UCLA）, lumbar curve index was evaluated by Seze measurement. [ Results] The mean fol- low - up was 57 months. According to Odom＇ s criteria, there were 57 excellent, 8 good, 5 fair and 2 poor results at final follow - up. The difference between clinical outcomes of baseline and the final follow - up showed statistical significance （P 〈 0. 05 ）. The difference between ROM of adjacent segments of baseline and the final follow - up showed statistical significance and the difference between the first segment above the fusion and the first segment below the fusion also showed statistical significance （P 〈 0. 05）. At the final follow - up, the LCI improved significantly from baseline （P 〉 0. 05 ） . [ Conclusion] PLIF provides a favorable clinical and radiological outcome at an average of 57 months follow - up, the degeneration of adjacent segments were statistical significantly, the range of operation, age, location of adjacent segment, LCI might affect the prevalence of adjacent segment degeneration.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第21期2121-2126,共6页
Orthopedic Journal of China
基金
上海市科委"创新行动计划"基础研究重点项目(编号:12JC1411302)
上海市教育委员会科研创新重点项目(编号:12ZZ079)
关键词
腰椎
融合
中期随访
邻近节段退变
lumbar, fusion, mid - term follow - up, adjacent segment degeneration
