摘要
目的评估MeyerdingⅡ~Ⅴ度腰椎滑脱症微创手术与开放手术的中期临床疗效,以及原位融合与复位融合对预后的影响。方法回顾性分析自2010-01—2015-09手术治疗的139例MeyerdingⅡ~Ⅴ度腰椎滑脱症,42例接受微创经椎间孔入路腰椎椎间融合手术治疗(微创手术组);97例接受开放手术治疗(开放手术组),其中63例经椎间孔入路腰椎椎间融合术,34例后路腰椎椎间融合术。微创手术组18例滑脱椎体原位融合(微创原位融合组),24例滑脱椎体复位融合(微创复位融合组)。开放手术组29例滑脱椎体原位融合(开放原位融合组),68例滑脱椎体复位融合(开放复位融合组)。结果微创手术组术后5年疼痛VAS评分、ODI指数高于开放手术组(P<0.05),两组椎间骨性融合率、并发症发生率差异无统计学意义(P>0.05)。微创复位融合组术后5年疼痛VAS评分、ODI指数、并发症发生率明显高于微创原位融合组(P<0.05),两组椎间骨性融合率差异无统计学意义(P>0.05)。开放原位融合组术后5年疼痛VAS评分、ODI指数高于开放复位融合组,椎间骨性融合率低于开放复位融合组,两组并发症发生率差异无统计学意义(P>0.05)。微创复位融合组术后5年疼痛VAS评分、ODI、并发症发生率高于开放复位融合组(P<0.05),而两组术后5年椎体滑脱率、椎间隙高度、节段前凸角、椎间骨性融合率差异无统计学意义(P>0.05)。结论对于中重度腰椎滑脱症患者,采用微创复位融合技术治疗的临床效果较差而且并发症发生率高;开放手术与微创手术患者的并发症发生率相当,但是开放手术患者可以获得更好的中期症状缓解与功能恢复。因此,中重度腰椎滑脱症患者应首选开放手术治疗,并在全面评估患者个体因素后尽可能复位滑脱椎体。
Objective To evaluate the mid-term clinical efficacy of minimally invasive surgery(MIS)and open surgery intreatment of Meyerding gradeⅡ~Ⅴlumbar spondylolisthesis,and the impact of in-situ fusion and reduction fusion on the prog-nosis.Methods A retrospective analysis was performed on 139 cases of Meyerding gradeⅡ-Ⅴlumbar spondylolisthesistreated with surgery from January 2010 to September 2015.Forty-two cases were treated with minimally invasive transforaminallumbar interbody fusion(MIS group)while 97 cases were treated with open surgery(open surgery group),including 63 cases oftransforaminal lumbar interbody fusion and 34 cases of posterior lumbar interbody fusion.In MIS group,18 cases were treatedwith in-situ fusion of spondylolisthetic vertebrae(MIS in-situ fusion group),and 24 cases were treated with reduction fusion(MIS reduction fusion group).In open surgery group,29 cases were treated with in-situ fusion of spondylolisthetic vertebrae(open in-situ fusion group),and 68 cases were treated with reduction fusion(open reduction fusion group).Results TheVAS pain score and ODI index at 5 years after surgery of the MIS group were higher than those of the open surgery group(P<0.05),and there was no significant difference between the two groups in the rate of intervertebral bone fusion and the rates ofcomplications(P>0.05).The VAS pain score,ODI index and complication rate at 5 years after surgery of the MIS reduction fu-sion group were significantly higher than those of the MIS in-situ fusion group(P<0.05),and there was no significant differencebetween the two groups in the rate of intervertebral bone fusion(P>0.05).5 years after surgery,the VAS pain score and ODI index of open in-situ fusion group were higher than those of open reduction fusion group,the intervertebral bone fusion rate ofopen in-situ fusion group was lower than those of open reduction fusion group,and there was no significant difference betweenthe two groups in the rates of complications(P>0.05).The VAS pain score,ODI index and complication
作者
曹峰
黄承
王振林
毛立挺
俞亚萍
陈燕
CAO Feng;HUANG Cheng;WANG Zhen-lin;MAO Li-ting;YU Ya-ping;CHEN Yan(Department of Orthopaedics,the 906th Hospital of Joint Logistic Support Force of PLA,Ningbo,Zhejiang 315040,China;不详)
出处
《中国骨与关节损伤杂志》
2023年第1期15-20,共6页
Chinese Journal of Bone and Joint Injury
基金
全军医药卫生科研基金课题(15MS021)
宁波市自然科学基金(2019A610248)
宁波市医学科技计划项目(2020Y25)
宁波市体育科学研究项目(20C01)
第906医院医药卫生科研基金(YG-2018002)。
关键词
腰椎滑脱症
经椎间孔入路腰椎椎间融合术
后路腰椎椎间融合术
微创手术
原位融合
Lumbar spondylolisthesis
Transforaminal lumbar interbody fusion
Posterior lumbar interbody fusion
Minimally invasive surgery
In-situ fusion
