血小板裂解液用于老年腰椎间盘突出症椎体融合术的临床疗效

  目的  评价血小板裂解液用于老年腰椎间盘突出症椎体融合术后治疗的临床疗效。  方法  以2018年4月—2020年4月于温州市中西医结合医院就诊并接受治疗的140例微创经椎间孔腰椎椎间融合术老年患者为研究对象，按照随机数字表法分为研究组和对照组，各70例。2组均实施微创经椎间孔腰椎椎间融合术，研究组在此基础上予以血小板裂解液椎间孔隙注射。记录患者手术指标，评价手术前后疼痛反应视觉模拟评分(VAS)评分]及腰椎功能水平腰椎Oswestry功能障碍指数(ODI)评分]，比较术后12个月患者腰椎影像学指标，观察术后并发症情况。  结果  研究组患者手术时间(182.41±17.28)min]显著长于对照组(167.86±15.49)min, t=5.219，P＜0.001]，而术中出血量(218.64±19.53)mL]及住院时间(6.59±0.71)d]与对照组(221.57±19.06)mL、(6.41±0.69)d]差异均无统计学意义(t=0.896、1.514，P=0.372、0.132)；研究组术后3、6、9、12个月VAS评分和ODI评分均显著低于对照组(均P＜0.001)；术后12个月，2组腰椎间融合率(98.57% vs. 94.28%)差异无统计学意义(χ2=0.830，P=0.362)，而研究组椎骨融合层数(4.68±0.52)层]和腰椎间隙高度(11.62±1.12)mm]均显著高于对照组(2.91±0.34)层、(10.53±1.04)mm，t=23.873、5.891，均P＜0.001]；2组术后12个月内均未出现并发症。  结论  血小板裂解液腰椎间孔隙注射可有效缓解老年腰椎间盘突出症椎体融合术后疼痛反应，改善腰椎功能恢复水平，提高腰椎间组织愈合程度和稳定性，且安全性高。 

Clinical effect of platelet lysate on lumbar interbody fusion in elderly patients with lumbar disc herniation

  Objective  To evaluate the clinical efficacy of platelet lysate in the treatment of elderly patients with lumbar disc herniation after vertebral fusion.  Methods  A total of 140 elderly patients with minimally invasive transforaminal lumbar interbody fusion who were in our hospital from April 2018 to April 2020 were randomly divided into study group and control group, with 70 cases in each group. Both groups were treated with minimally invasive transforaminal lumbar interbody fusion, and the study group was treated with platelet lysate injection. The operation indexes were recorded, and the pain reaction and lumbar function of the two groups were evaluated before and after operation. The differences in lumbar imaging indexes were compared 12 months after operation, and the postoperative complications were observed.  Results  The operation time of the study group was (182.41±17.28) min, which was significantly longer than that of the control group (167.86±15.49) min, t=5.219, P < 0.001, but no significant differences in blood loss and hospital stay were found between the control group and control group (218.64±19.53) mL vs. (221.57±19.06) mL and (6.59±0.71) days vs. (6.41±0.69) days; t=0.896, 1.514; P=0.372, 0.132]. The visual analogue scale (VAS) score and ODI score at 3, 6, 9 and 12 months after operation in the study group were significantly lower than those in the control group (all P < 0.001). In addition, no significant difference in the fusion rate was found between the two groups 12 months after operation (98.57% vs. 94.28%, χ2=0.830, P=0.362), whereas the number of fusion layers (4.68±0.52) and the height of lumbar intervertebral space (11.62±1.12) mm] in the study group were significantly higher than those in the control group (2.91±0.34) and (10.53±1.04) mm; t=23.873, 5.891, all P < 0.001)]. No complications in the two groups within 12 months after operation.  Conclusion  Platelet lysate injection into lumbar intervertebral space can relieve the pain reaction after lumbar fusion in elderly patients with lumbar disc herniation and improve the recovery level of lumbar function, the healing degree and stability of lumbar intervertebral tissue. This method has high safety.