腰椎后外侧融合术与360°融合术在严重腰椎管狭窄症治疗中的应用

目的比较腰椎后外侧融合术(PLF)与腰椎360°融合术(CF)在严重腰椎管狭窄症治疗中的临床疗效。方法回顾性分析2014年1月至2017年8月在我科住院治疗的161例不合并椎间盘突出或脱出的严重腰椎管狭窄症患者的临床资料,根据手术方式将患者分为腰椎后外侧融合组(PLF组,81例)和腰椎360°融合组(CF组,80例)。PLF组行腰椎后侧减压联合椎弓根螺钉固定及后外侧融合术;CF组行腰椎椎间盘切除联合后侧减压、椎弓根螺钉固定及360°融合术。比较2组患者术中出血量、手术时间、手术费用及术后并发症发生率;比较2组患者腰腿痛VAS、ODI、腰痛JOA评分评估临床症状;比较2组患者椎间隙高度、腰椎前凸角、融合率评估术后腰椎矢状位平衡及腰椎稳定性。结果术后2组患者的VAS、JOA、ODI较术前均明显改善,与术前比较差异有统计学意义(P<0.01),但2组间比较差异无统计学意义(P>0.05);2组患者术后均恢复了腰椎前凸角和椎间隙高度,且2组术后融合率比较差异无统计学意义(P>0.05);CF组的手术时间、术中出血量、手术费用比PLF组更多,2组比较差异有统计学意义(P<0.01);此外,2组共有8例发生术后并发症,其中PLF组1例(1.23%),CF组7例(8.75%),2组比较差异有统计学意义(P<0.05)。结论对于不合并椎间盘突出或脱出的严重腰椎管狭窄症,行腰椎后侧减压联合椎弓根螺钉固定及后外侧融合术后可以明显缓解临床症状,实现手术节段间骨性融合,达到与腰椎椎间盘切除联合后侧减压、椎弓根螺钉固定及360°融合术同样的手术效果,且手术时间、术中出血量、手术费用、并发症更少。

Clinical application of lumbar posterolateral fusion and lumbar circumferential fusion in the treatment of severe lumbar spinal stenosis

Objective To compare the clinical efficacy of lumbar posterolateral fusion(PLF)and lumbar circumferential fusion(CF)in the treatment of severe lumbar spinal stenosis.Methods The clinical data of 161 patients of severe lumbar spinal stenosis without disc herniation or prolapse who were hospitalized in our department from January 2014 to August 2017 were retrospectively analyzed.These patients were divided into the posterolateral fusion group(PLF group,81cases)and the circumferential fusion group(CF group,80 cases)according to the different surgery methods.Patients of the PLF group underwent lumbar posterior decompression,pedicle screw fixation and posterolateral fusion,while patients of the CF group underwent lumbar discectomy,posterior decompression,pedicle screw fixation and circumferential fusion.The intraoperative blood loss,operation time,operation cost,and incidence of postoperative complications of the two groups were compared.VAS,ODI and JOA scores of the two groups were compared to evaluate the clinical symptoms.Height of intervertebral space,lumbar lordosis angle and fusion rate were compared between the two groups to evaluate lumbar sagittal balance and lumbar stability.Results Patients in both of the two groups obtained significant improvement in VAS,JOA and ODI compared with the preoperative status,and there were statistically significant differences before and after surgery(P<0.01),but there was no significant difference between two groups after surgery(P>0.05).Patients in both of the two groups achieved correction of lumbar lordosis and intervertebral space height,and there was no significant difference in fusion rate between the two groups(P>0.05).Operation time,intraoperative blood loss,and operation cost of the CF group were higher than those in the PLF group,and there were statistically significant differences between the two groups(P<0.01).Postoperative complications occurred in 8 patinets,including 1 patient(1.23%)in the PLF group and 7 patients(8.75%)in the CF group,with statistically significant difference between the two groups(P<0.05).Conclusion Lumbar posterior decompression and pedicle screw fixation combined with posterolateral fusion can successfully relieve clinical symptoms and achieve intersegmental bone fusion with less operation time,intraoperative blood loss,operation cost,and postoperative complications for patients of severe lumbar spinal stenosis without disc herniation or prolapse.