摘要
目的探讨微创经椎间孔入路腰椎椎体间融合术(MIS-TILF)与后路减压固定融合矫形术(PLIF)治疗退行性腰椎侧弯合并腰椎管狭窄症的疗效。方法选取自2018年5月至2020年5月收治的104例退行性腰椎侧弯合并腰椎管狭窄症患者为研究对象。根据手术方案将患者分为A组和B组,每组各52例。A组患者行MIS-TILF,B组患者行PLIF。观察两组患者的围术期指标、并发症发生情况,对比术前及术后3、5 d血清谷胱甘肽过氧化物酶(GSH-Px)、活性氧(ROS)、过氧化氢酶(CAT)水平,术前及术后1、3个月疼痛程度(VAS)、腰椎功能(ODI)、影像学指标(腰椎前凸角、冠状面Cobb角、顶椎偏移距离)、脊髓功能[腓总神经传导速度(NCV)、潜伏期(DL)]。结果A组手术时间长于B组,卧床时间、住院时间短于B组,术后引流量、术中出血量少于B组,手术时间长于B组,差异均有统计学意义(P<0.05)。术后3、5 d,A组患者血清GSH-Px、CAT水平均高于B组,ROS水平低于B组,差异有统计学意义(P<0.05)。A组患者术后1、3个月,VAS、ODI评分均低于B组,差异有统计学意义(P<0.05)。术后1、3个月,A组患者腰椎前凸角大于B组,冠状面Cobb角小于B组,顶椎偏移距离短于B组,差异有统计学意义(P<0.05)。术后1、3个月,A组患者腓总神经NCV高于B组,DL低于B组,差异有统计学意义(P<0.05)。A组和B组患者并发症的发生率分别为5.8%(3/52)和15.4%(8/52),差异无统计学意义(P>0.05)。结论与PLIF手术相比较,MIS-TLIF术治疗退行性腰椎侧弯合并腰椎管狭窄症,可改善围术期指标,缓解疼痛,恢复腰椎功能,且对氧化应激影响较小。
Objective To investigate the effect of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TILF)and posterior lumbar interbody fusion(PLIF)in the treatment of degenerative lumbar scoliosis with lumbar spinal stenosis.Methods A total of 104 patients with degenerative lumbar scoliosis with lumbar spinal stenosis who were admitted from from May 2018 to May 2020.According to the surgical plan,patients were divided into group A and group B,with 52 patients in each group.Patients in group A were given MIS-TILF and patients in group B were given PLIF.The perioperative indicators and complication rates of the two groups were observed.And serum glutathione peroxidase(GSH-Px),reactive oxygen species(ROS)and catalase(CAT)levels were compared pre-operation and 3,5 days after surgery.visual analogue scale(VAS),Oswestry disability index(ODI),imaging indicators(lumbar lordosis angle,coronal Cobb angle,offset distance of the top spine),spinal cord function[nerve conduction velocity(NCV),distal latency(DL)]were compared pre-operation and 1,3 months after surgery.Results The operation time in group A was longer than that in group B,the bed stay and hospital stay were shorter than those in group B,and the postoperative drainage and intraoperative bleeding were less than those in group B(P<0.05);3,5 days after surgery,the levels of serum GSH-PX and CAT in group A were higher than those in group B,and the levels of ROS were lower than those in group B(P<0.05);At 1,3 months after operation,VAS,ODI scores,coronal Cobb angle,apical vertebral offset distance,DL in group A were lower than those in group B,lumbar lordosis angle and common peroneal nerve NCV were higher than those in group B(P<0.05);There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Compared with PLIF,mis-tlif in the treatment of degenerative lumbar scoliosis combined with lumbar spinal stenosis can improve perioperative indexes,relieve pain and restore lumbar function,and has little effect on oxidative stress.
作者
王文斌
赵强
王建武
党建军
崔文宁
WANG Wen-bin;ZHAO Qiang;WANG Jian-wu;DANG Jian-jun;CUI Wen-ning(Departmeng of Orthopaedics,Chang An Hospital,Xi′an 710016,China)
出处
《创伤与急危重病医学》
2022年第1期49-54,共6页
Trauma and Critical Care Medicine
关键词
微创经椎间孔入路
腰椎椎体间融合术
后路减压固定融合矫形术
退行性腰椎侧弯
腰椎管狭窄症
Minimally invasive transforaminal approach
Lumbar interbody fusion
Posterior lumbar interbody fusion
Degenerative lumbar scoliosis
Lumbar spinal stenosis
