摘要
目的比较3种不同术式治疗腰椎管狭窄症的临床效果。方法2008年1月至2013年1月手术治疗腰椎管狭窄症患者140例，其中50例采用经后路腰椎椎体间融合术（PLIF术，PLIF组），40例采用后路经椎间孔椎间融合术（TLIF术，TLIF组），50例采用改良术式（改良术组）。术后3和6个月，采用日本骨科学会（JOA）评分、视觉模拟疼痛评分（VAS）及影像学检查评价治疗效果。结果改良术组手术时间最短（135．5±42．5）min，术中出血量最低（260．2±86．2）ml，TLIF组次之[（147．5±41．4）min和（300．2±80．1）ml]，PLIF组手术时间最长[（170．6±25．6）min]，出血量最多[（430．1±46．3）ml]，差异均有统计学意义（F值分别为10．02和9．20，均P〈0．05）。PLIF组、TLIF组和改良术组的优良率分别为90％（45／50）、92％（37／40）和90（45／50）。TLIF组和改良术组均无并发症发生，PLIF组出现2例脑脊液漏。JOA评分：3组术后3和6个月均较术前改善，差异有统计学意义（F值改良术组为10．66、TLIF组为9．68、PLIF组为11．03，均P〈0．05）；3组间术前评分、术后3和6个月评分改善情况比较，差异均无统计学意义（F值分别为2．23、1．32和0．79，均P〉0．05）。VAS评分：3组术后3和6个月评分均较术前改善，差异均有统计学意义（F值改良术组为8．61、TLIF组为8．86、PLIF组为12．32，均P〈0．05）；3组间术前评分比较差异有统计学意义（F=2．13，P〉0．05），术后3和6个月改良术组和TLIF组评分改善优于PLIF组[术后3个月分别为（4．9±1．2）、（4．5±1．0）和（3．9±0．9）分，术后6个月分别为（6．1±1．4）、（5．9±1．2）和（5．1±1．4）分]，差异均有统计学意义（F值分别为10．02和9．46，均P〈0．05），TLIF组和改良术组评分改善差异无统计学意义（P〉0．05）。影像学检查示椎间融合良好。结论改良�
Objective To evaluate the clinical outcomes of lumbar spinal stenosis treated with three different surgical modalities. Methods One hundred and forty patients were treated with posterior lumbar interbody fusion （ PLIF, n = 50 ）, transforaminal lumbar interbody fusion （ TLIF, n = 40 ） or modified method （ n = 50 ）. The operation time and intraoperative blood loss were compared. The outcomes were evaluated with Japanese Orthopedic Association （ JOA ） score and visual analogue scale （ VAS ） , and the radiographic findings were also reviewed. Results The operation time was shorter and the intraoperative blood loss was less in modified group than those in other two groups （ F = 10. 02, P 〈 0. 05 ）. The excellent and good rate was 90% （45/50） in PLIF group , 92% （37/40） in TLIF group and 90% （45/50） in modified group. No complication happened in both TLIF group and modified group . Two patients had cerebrospinal fluid leakage in PLIF group. The JOA scores and VAS scores were significantly improved 3 and 6 months after surgery in three groups （ F = 10. 66,9.68,11.03, all P 〈 0. 05 ）. There were no significant differences in JOA scores and VAS scores among three groups before operation （ P 〉 0. 05 ） , also in JOA scores after operation among three groups. The VAS scores in TLIF group and modified group 3 and 6 months after operation were significantly lower than those in PLIF group （F = 9.46,10. 02, all P 〈 0. 05 ） , but there was no significant difference between TLIF group and modified group. Interbody fusion was good in all threegroups. Conclusions Three surgical methods have good clinical outcomes for lumbar spinal stenosis. But compared with PLIF and TLIF, the modified method has less blood loss, shorter operation time and less pain after operation.
出处
《中华全科医师杂志》
2015年第12期942-946,共5页
Chinese Journal of General Practitioners
关键词
椎管狭窄
腰椎
椎弓根螺钉固定
椎间融合术
Spinal stenosis,lumbar vwetebrae
Pedicle screw fixation
Interbody fusion
