棒连接翻修术治疗腰椎术后邻椎病的临床疗效

目的探讨新型棒连接翻修术和常规棒替换翻修术在腰椎后路融合术后邻椎病翻修手术中的安全性和有效性。方法2018年1月—2020年9月,海军军医大学长征医院收治腰椎后路融合术后邻椎病须行翻修手术的患者34例,其中17例采用常规棒替换翻修术治疗(替换组),17例采用新型棒连接器进行棒连接翻修术治疗(连接组)。记录并比较2组初次手术节段、需翻修节段、手术时间、术中出血量、术后引流量、手术并发症及住院时间,术前及术后2、6、12个月采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评价疗效。结果所有手术顺利完成。所有患者随访超过12个月。连接组术中出血量、术后引流量明显少于替换组,手术时间短于替换组,差异均有统计学意义(P<0.05)。2组术后各时间点VAS评分和ODI较术前显著改善,且术后2个月连接组VAS评分和ODI优于替换组,差异均有统计学意义(P<0.05)。连接组术后发生脑脊液漏1例,神经功能下降1例;替换组术后发生脑脊液漏1例,早期伤口感染1例;2组手术并发症差异无统计学意义(P>0.05)。结论腰椎翻修手术中采用棒连接翻修术可获得与常规棒替换翻修术相似的治疗效果,并且具有创伤小、恢复快的优点。

Clinical effect analysis of rod connection revision in treatment of adjacent segment diseases after lumbar fusion

Objective To investigate the safety and effectiveness of new rod connection revision and conventional rod replacement revision for adjacent vertebral disease after lumbar fusion. Methods From January 2018 to September 2020,34 patients with adjacent segment diseases requiring revision surgery after lumbar fusion were treated in Changzheng Hospital of Naval Medical University. Among them,17 patients were treated by conventional rod replacement revision(replacement group) and 17 treated by rod connection revision with new rod connector(connection group). The initial operation segment,the segment to be repaired,operation time,intraoperative blood loss,postoperative drainage volume,complications and hospital stay were recorded and compared between the 2 groups. The pain visual analogue scale(VAS) score and Oswestry disability index(ODI) at pre-operation and postoperative 2,6 and 12 months were used to evaluate the therapentic effect. Results All the operations were successfully completed. All the patients were followed up for more than 12 months. The intraoperative blood loss and postoperative drainage volume in the connection group were significantly less than those in the replacement group,and the operation time was shorter than that in the replacement group,and the differences were statistically significant(P<0.05). The VAS score and ODI of the 2 groups were significantly improved at each time point after operation,and the VAS score and ODI of the connection group at postoperative 2 months were better than those of the replacement group,and the differences were statistically significant(P<0.05). In the connection group,cerebrospinal fluid leakage occurred in 1 case and neurological function decreased in 1;in the replacement group,cerebrospinal fluid leakage occurred in 1 case and early wound infection in 1. There was no significant difference in surgical complications between the 2 groups(P>0.05). Conclusion In lumbar revision surgery,the use of rod connection revision can achieve a safe and effective outcome similar to that of conventional rod replacement revision,with the advantages of less trauma and faster recovery.