扩大PLIF治疗腰椎退行性疾病疗效分析

目的探讨扩大腰椎后路椎间融合术(posterior lumbar interbody fusion,PLIF)、cage椎间融合器结合椎弓根钉内固定治疗腰椎退行性疾病的临床疗效。方法回顾性分析我院2008年2月～2010年11月采用扩大PLIF、cage椎间融合器结合椎弓根钉内固定治疗腰椎退行性疾病66例患者的临床资料,其中男性19例,女性47例,平均年龄51(35～82)岁;腰椎间盘突出症21例,腰椎滑脱13例,腰椎管狭窄症32例,行单节段融合48例,行双节段融合18例。通过术前、术后及末次随访时X线片对比,对融合率、对JOA评分及椎间高度变化进行评估。结果本组66例均获随访,随访时间平均18(12～27)个月。所有患者症状消失或显著改善,无术后并发症发生。63例发生椎间融合,融合率达95.5%,其余3例未获得融合。术前、术后1周及术后12月以上末次随访时JOA评分分别为(13.4±3.2)分、(21.2±3.5)分及(23.3±3.8)分,融合节段椎间隙平均高度分别为(7.6±2.8)mm、(11.0±1.6)mm及(10.3±1.5)mm,术后1周及术后末次随访JOA评分、融合节段椎间隙平均高度与术前比较差异均有统计学意义(P<0.05),而术后不同时点间JOA评分、椎间隙平均高度比较差异无统计学意义(P>0.05)。结论扩大PLIF避免了过度牵拉可能造成神经根和硬膜囊的损伤,cage椎间融合器加椎弓根钉内固定行椎间融合治疗腰椎退行性疾病,可有效恢复椎间高度,提高融合率,是一种有效的治疗方法。

Effect of Surgical Decompression, Expanded Posterior Lumbar Interbody Fusion and Pedicle Screw Fixation for Lumbar Degenerative Disease

Objective To study the effect of surgical decompression, expanded posterior lumbar inter- body fusion and pedicle screw fixation for the treatment of lumbar degenerative diseases. Methods The clinic data of 66 eases with lumbar degenerative disease admitted from February 2008 to November 2010 were analyzed retrospectively, including 19 males and 47 females, aged from 35 to 82 years with an average age of 51. Among them, 21 patients were lumbar intervertebral disc protrusion, 13 were lumbar spondylolisthesis and 32 were lumbar spinal stenosis. All 66 cases were treated by laminectomy, disceetomy, nerve root loose- ning, posterior lumbar interbody fusion and pedicle screw fixation. Single interbody fusion was carried out in 48 cases and two interbody fusions in 18 cases. The fusion rate, JOA scores and the average height of inter- vertebral space were evaluated. Results All 66 cases were followed up for 12 to 27 months with an average of 18 months. The symptoms were disappeared or improved obviously without postoperative complications in all patients. Interbody fusion was achieved in 63 cases and the fusion rate was 95.5% one year after the oper- ation, and non-fusion was in the other 3 cases. The JOA of preoperative, 1 week postoperative and final fol- low-up（ 12 months after the operation） was （ 13.4 ± 3.2）, （21.2 ± 3.5 ） and （ 23.3± 3.8 ） respectively, there was statistic difference between JOA of preoperative and that of 1 week postoperative or final follow-up （P〈0.05）. The average height ofintervertebral space was （7.6 ±2.8）mm, （11.0±1.6）mm and （ 10.3 ± 1.5） mm respectively in preoperative, 1 week postoperative and final follow-up, and there was sta- tistic difference in average height of intervertebral space between preoperative and 1 week postoperative or final follow-up （ P 〈 0.05 ）. No statistic difference was found in both JOA and intervertebral space height be- tween 1 week postoperative and final follow-up （ P 〉 0.05 ）. Conclusion The procedure of surgical decom- pression, expended postural lumbar interbody fusion and pedicl e screw fixation can avoid injuries of nerve root and dural sac associated with excessive tension and restore the height of intervertebral space, and it is an effec- tive method for the treatment of lumbar degenerative diseases.