摘要
目的分析单侧入路双侧减压经椎间孔腰椎椎间融合术治疗腰椎管狭窄症的效果。方法回顾性选取商丘市第一人民医院2017年10月至2019年10月腰椎管狭窄症患者93例,根据手术方案不同分为两组,其中47例行单侧入路双侧减压经椎间孔腰椎椎间融合术为观察组,另46例行双侧入路棘突旁小切口双侧减压椎体间融合术为对照组,比较两组术中失血量、术后引流量、手术时间、住院时间、手术前后肌酸激酶(CPK)、腰椎功能(ODI)、疼痛程度(VAS)、腰椎功能性障碍指数(JOA)、术后并发症发生率。结果两组术中失血量、手术时间、住院时间比较无明显差异;观察组术后引流量较对照组少;术后1、3、7 d两组CPK水平与术前比较,差异有统计学意义(P<0.05),且术后1、3 d观察组CPK水平较对照组低(P<0.05);术后3、6、12个月两组ODI、VAS评分均低于术前,且观察组低于对照组(P<0.05);术后3、6个月两组JOA评分均高于术前,且观察组高于对照组(P<0.05);术后1 d两组血清TNF-α、IL-1α高于术前(P<0.05),但两组组间比较无明显差异(P>0.05);观察组术后并发症发生率4.26%(2/47)与对照组8.70%(4/46)对比无明显差异;术后3个月两组SF-36评分均高于术前,且观察组高于对照组(P<0.05)。结论单侧入路双侧减压经椎间孔腰椎椎间融合术具有创伤小、安全性高等优势,治疗腰椎管狭窄症患者可减少术后引流量,降低肌肉损伤,促进术后腰椎功能恢复,缓解腰椎疼痛,改善生活质量,远期效果良好。
Objective To analyze the effect of unilateral approach and bilateral decompression transforaminal lumbar interbody fusion in the treatment of patients with lumbar spinal stenosis.Methods Atotal of 93 patients with lumbar spinal stenosis from October 2017 to October 2019 in Shangqiu First People’s Hospital were retrospectively selected.According to different surgical plans,they were divided into 2 groups.Among them,47 cases underwent unilateral approach and bilateral decompression transforaminal lumbar interbody fusion as the observation group,and the other 46 cases underwent bilateral paraspinous small incision and bilateral decompression and interbody fusion as the control group.The intraoperative blood loss,postoperative drainage,operation time,hospital stay,C reatine phosphokinase(CPK),Oswestry Disability Index(ODI),Visual Analogue Scale(VAS),Japanese Orthopaedic Association Score(JOA)before and after surgery,and postoperative complication rate were compared between the two groups.Results There was no significant difference in blood loss,operation time,and hospitalization time between the two groups(P>0.05).The postoperative drainage in the observation group was less than that in the control group(P<0.05).There was a statistically significant difference in CPK levels between the two groups on the 1 st,3 rd,and 7 th day after surgery(P<0.05).The CPK level of the observation group was lower than that of the control group at 1 and 3 days after operation(P<0.05).The ODI and VAS scores of the 2 groups were lower than those before the operation at 3 months,6 months,and 12 months after operation,and the observation group was lower than the control group(P<0.05).The JOA scores of the two groups were higher than those before the operation at 3 months and 6 months after operation,and the observation group was higher than the control group(P<0.05).Serum TNF-α and IL-1α in the 2 groups were higher than before the operation on the 1 st day after operation(P<0.05),but there was no significant difference between the two
作者
李鹏程
LI Peng-cheng(Department of Spine Surgery,The First People's Hospital of Shangqiu City,Shangqiu 476000 China)
出处
《内蒙古医学杂志》
2021年第9期1040-1044,共5页
Inner Mongolia Medical Journal
基金
河南省卫健委医学教育研究课题(编号:Wjlx2017027)。
关键词
腰椎管狭窄症
经椎间孔腰椎椎间融合术
单侧入路
lumbar spinal stenosis
transforaminal lumbar interbody fusion
unilateral approach
