摘要
目的:分析Wiltse入路腰椎椎体间融合术治疗极外侧腰椎间盘突出症患者的效果。方法:选取2017年6月—2019年4月河南科技大学第二附属医院收治的106例极外侧腰椎间盘突出症患者作为研究对象,将接受传统后正中入路腰椎椎体间融合术治疗的52例患者作为传统组,将接受Wiltse入路腰椎椎体间融合术治疗的54例患者作为Wiltse组。比较两组患者手术相关指标(手术时间、术中失血量、术后引流量),术后1年健侧多裂肌残存率(L3~L4、L4~L5、L5~S1节段),术前、术后6个月、术后1年疼痛程度[腰痛、下肢痛,视觉模拟量表(VAS)评分],腰椎功能[Oswestry功能障碍指数(ODI)评分],术前、术后1 d,术后3 d应激反应水平[血清促肾上腺皮质激素(ACTH),皮质醇(Cor),肿瘤坏死因子-α(TNF-α)],术前、术后3 d,术后7 d血清肌酸激酶(CK)水平。结果:Wiltse组手术时间较传统组短,术中失血量、术后引流量较传统组少,差异有统计学意义(t=5.381、11.155、10.447,P<0.05);术后1年,Wiltse组L3~L4、L4~L5、L5~S1节段多裂肌残存情况均较传统组高,差异有统计学意义(t=14.186、13.919、12.099,P<0.05);术后6个月、术后1年,Wiltse组腰痛VAS评分、下肢痛VAS评分、ODI评分均低于传统组,差异有统计学意义(t=5.677、6.755、3.966、3.668、4.869、13.972,P<0.05);两组患者术后1 d和3 d血清ACTH、Cor、TNF-α水平较术前升高,但Wiltse组低于传统组,差异有统计学意义(t=9.202、7.050、14.597、15.455、9.743、15.566,P<0.05);两组患者术后3 d和术后7 d血清CK水平均较术前有所升高,但Wiltse组均低于传统组,且术后7 d低于术后3 d,差异有统计学意义(t=6.162、23.384,P<0.05)。结论:Wiltse入路腰椎椎体间融合术治疗极外侧腰椎间盘突出症,能优化手术相关指标,减少椎旁肌损伤,缓解临床疼痛程度,促进腰椎功能恢复,减少应激反应。
Objective: To analyze the effect of Wiltse approach lumbar interbody fusion in the treatment of patients with extreme lateral lumbar disc herniation. Methods: A total of 106 patients with extreme lateral lumbar disc herniation who were admitted to the hospital from June 2017 to April 2019 were retrospectively selected as the research subjects. 52 patients who received traditional posterior median approach lumbar interbody fusion were selected as the traditional group, and 54 patients who received Wiltse approach lumbar interbody fusion were selected as the Wiltse group. The operation-related indicators(operation time, intraoperative blood loss, postoperative drainage), 1-year postoperative residual rate of the contralateral multifidus(L3-L4, L4-L5, L5-S1 segments), pain level before surgery, 6 months after surgery, and 1 year after surgery(lumbago, lower extremity pain, visual analog scale [VAS] score), lumbar spine function [Oswestry Disability Index(ODI) score], stress response levels(serum adrenocorticotropic hormone [ACTH], cortisol [Cor], tumor necrosis factor-α [TNF-α]) before surgery, 1 d after surgery, and 3 d after surgery,the serum creatine kinase(CK) levels before surgery, 3 d after surgery, and 7 d after surgery were compared between the two groups. Results: The operation time in the Wiltse group was shorter than that in the traditional group, and the intraoperative blood loss and postoperative drainage were less than those in the traditional group, and the differences were statistically significant(t=5.381, 11.155, 10.447, P<0.05). One year after operation, the residual status of multifidus in the L3-L4, L4-L5, and L5-S1 segments in the Wiltse group was higher than that in the traditional group, and the difference was statistically significant(t=14.186,13.919, 12.099, P<0.05). At 6 months and 1 year after operation, the VAS score of low back pain, VAS score of lower limb pain and ODI score of Wiltse group were lower than those of traditional group, and the differences were statistically significant
作者
吕海文
LÜHai-wen(Orthopaedics Department,The Second Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan,471000,China)
出处
《黑龙江医学》
2022年第16期1947-1950,共4页
Heilongjiang Medical Journal
