摘要
目的探讨猫眼侧方入路腰椎椎体间融合(crenel lateral interbody fusion,CLIF)后路内固定术治疗严重退行性腰椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)的临床疗效。方法2019年10月至2021年2月因严重DLSS(至少一个节段为Schizas分级C级)接受CLIF后路内固定术治疗的71例患者纳入研究。随机分为两组:CLIF+后路固定组,36例46个手术节段,接受CLIF+后路内固定术;CLIF+后路减压固定组,35例46个手术节段,接受CLIF+后路椎板减压内固定术。比较两组患者的围手术期疗效及术后3、6和12个月的随访结果。主要临床评价指标包括Oswestry功能障碍指数(Oswestry disability index,ODI)、苏黎世跛行量表(Zurich claudication questionnaire,ZCQ)及疼痛视觉模拟评分(visual analogue scale,VAS)。结果两组患者术前椎管前后径、中央椎管面积、ODI、ZCQ和VAS评分的差异均无统计学意义。CLIF+后路固定组的手术时间为(157.2±29.1)min、术中出血量为(75.6±39.1)ml、术后引流量为(136.9±73.9)ml、术后住院时间为(5.3±1.1)d,均小于CLIF+后路减压固定组[分别为(180.6±26.8)min、(108.6±43.3)ml、(220.5±121.3)ml、(6.6±2.3)d],组间差异有统计学意义(P<0.05)。术后12个月时CLIF+后路固定组患者ODI由术前42.24%±10.70%降低至18.21%±11.49%,ZCQ症状评分由术前(2.89±0.38)分降低至(1.61±0.41)分,ZCQ功能评分由术前(2.31±0.45)分降低至(1.50±0.37)分,腰痛VAS评分由术前(5.56±1.19)分降低至(1.97±1.13)分,下肢痛VAS评分由术前(4.44±1.81)分降低至(0.94±1.26)分;CLIF+后路减压固定组ODI评分由术前43.65%±14.93%降低至17.36%±12.15%,ZCQ症状评分由术前(2.92±0.52)分降低至(1.65±0.39)分,ZCQ功能评分由术前(2.37±0.52)分降低至(1.55±0.39)分,腰痛VAS评分由术前(5.63±1.40)分降低至(2.34±1.47)分,下肢痛VAS评分术前(4.37±2.14)分降低至(0.83±1.20)。术后12个月时ZCQ满意度评分组间差异无统计学意义[(1.25±0.45)分,(1.26±0.43)�
Objective To investigate the clinical outcomes of minimally invasive lateral lumbar interbody fusion(LLIF)and the necessity to perform LLIF plus posterior direct decompression in the treatment of severe degenerative lumbar spinal stenosis(DLSS).Methods In this prospective randomized,controlled trial,we assigned 71 patients,who were 50 to 80 years old,and diagnosed with severe DLSS(Schizas Classification grade C on magnetic resonance imaging),in a 1∶1 ratio to undergo either one-stage LLIF plus posterior internal fixation(treatment group)or CLIF plus posterior internal fixation with laminectomy(control group).Demographic and perioperative data were collected and compared.The clinical outcome measures included Oswestry Disability Index(ODI),Zurich Claudication Questionnaire(ZCQ)score as well as visual analogue scale(VAS).Patients were followed up for at least 1 year.Results The treatment group included 36 patients with 46 surgical levels,while the control group included 35 patients with 46 surgical levels.The baseline demographic data of the 2 groups were equivalent in preoperative central canal areas,spinal canal anteroposterior diameter,disc height,ODI,ZCQ score for symptom severity and physical function,as well as VAS scores for back and leg pain.The mean operative time,blood loss,drainage volume and hospital stay of the treatment group are significantly less than the control group(157.2±29.1 min vs.180.6±26.8 min,75.6±39.1 ml vs.108.6±43.3 ml,136.9±73.9 ml vs.220.5±121.3 ml,5.3±1.1 d vs.6.6±2.3 d).There were 2 cases with dura tear and 1 case with wound infection in control group.Thus,the surgical trauma and complications of the control group were more than the treatment group.At 1-year follow-up,the mean ODI score of treatment group improved from 42.24%±10.70%preoperatively to 18.21%±11.49%,the mean ZCQ symptom severity from 2.89±0.38 to 1.61±0.41,the mean ZCQ physical function from 2.31±0.45 to 1.50±0.37,the mean VAS for back from 5.56±1.19 to 1.97±1.13 and the mean VAS for leg from 4.44±1.8
作者
李君
李方财
陈其昕
陈维善
张宁
陈刚
陆惠根
李浩
王智伟
Li Jun;Li Fangcai;Chen Qixin;Chen Weishan;Zhang Ning;Chen Gang;Lu Huigen;Li Hao;Wang Zhiwei(The Second Affiliated Hospital of Medical College Zhejiang University,Hangzhou 310009,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2023年第11期687-696,共10页
Chinese Journal of Orthopaedics
基金
国家重点研发计划课题(2022YFC2407202)。
关键词
腰椎
椎管狭窄
脊柱融合术
减压
随机对照试验
Lumbar vertebrae
Spinal stenosis
Spinal fusion
Decompression
Randomized controlled trial
