摘要
目的比较后路开窗髓核摘除联合单侧弹性棒内固定术与后路髓核摘除植骨融合术(PLIF)治疗腰椎间盘突出症的早期疗效。方法选取85例手术治疗腰椎间盘突出症并获得完整随访的患者资料,根据术式不同分为非融合组(采用后路开窗髓核摘除联合单侧弹性棒内固定,37例)和融合组(采用PLIF,48例)。结果患者均获得随访,时间6～12个月。手术时间、术中失血量、术后引流量、下地时间非融合组均少于融合组(P <0. 05)。随访期间两组均无复发病例,伤口愈合不良融合组3例,非融合组1例,该4例经加强换药后均痊愈;融合组断棒1例,翻修后症状缓解;融合组邻近节段退变6例,其中2例出现症状,翻修后缓解。融合组并发症发生率为20. 83%,非融合组并发症发生率为2. 70%,两组比较差异有统计学意义(P <0. 05)。末次随访时VAS、JOA评分非融合组优于融合组(P <0. 05); MacNab优良率:非融合组为83. 78%,优于融合组的72. 92%,差异有统计学意义(P <0. 05)。结论后路开窗髓核摘除联合单侧弹性棒内固定术较PLIF早期临床疗效更优,并发症发生率低。
Objective To compare the early efficacy of discectomy combined with dynamic internal fixation and posterior lumbar interbody fusion(PLIF)for lumbar disc herniation.Methods The 85 cases who had the treatment of single segment lumbar disc disease by operation,were divided into two groups according to the different surgical methods:non-fusion group(37 cases,using discectomy combined with dynamic internal fixation)and fusion group(48 cases,using PLIF).Results All patients were followed up for 6~12 months.The operative time,intraoperative blood loss,postoperative drainage and got out of bed time in the non-fusion group were all less than those in the fusion group(P<0.05).There were no recurrences in both groups during follow-up.Poor wound healing occured in 3 patients in fusion group and 1 in the non-fusion group,all of which healed after strengthening the dressing.One case in fusion group got rod broken and the symptoms were relieved after revision.The 6 cases of adjacent segment degeneration were found in fusion group,of which 2 cases had symptoms and relieved after revision.Complication incidence rate of MacNab in fusion group was 20.83%,and in non-fusion group was 2.70%,the difference was statistically significant(P<0.05).At the last follow-up,pain VAS,JOA score of the non-fusion group were superior to the fusion group(P<0.05).The excellent-good rate of MacNab in non-fusion group was 83.78%,and in fusion group was 72.92%,the difference was statistically significant(P<0.05).Conclusions The discectomy combined with dynamic internal fixation can achieve satisfactory clinical effect and lower incidence rate of complication.
作者
段大鹏
卫文博
范亚一
李伟伟
段亮
宋启春
徐洪海
DUAN Da-peng;WEI Wen-bo;FAN Ya-yi;LI Wei-wei;DUAN Liang;SONG Qi-chun;XU Hong-hai(Dept of Orthopaedics,Shaanxi Provincial People′s Hospital,Xi′an,Shaanxi 710068,China)
出处
《临床骨科杂志》
2019年第1期35-38,共4页
Journal of Clinical Orthopaedics
基金
陕西省科技统筹创新工程计划项目(编号:2015KTCL03-02)
关键词
腰椎间盘突出症
腰椎后路椎间融合术
弹性内固定
微创
lumbar disc herniation
posterior lumbar interbody fusion
dynamic internal fixation
minimally invasive
