改良PLIF术治疗腰椎管狭窄症的临床疗效观察

目的比较改良后路椎体间植骨融合术(posterior lunbar interbody fusion,PLIF)与传统PLIF术治疗腰椎管狭窄症的临床效果。方法对2008年9月至2010年8月使用改良PLIF术和传统PLIF术治疗腰椎管狭窄症各50例患者资料进行回顾性研究分析。改良PLIF术组男30例,女20例,年龄48～72岁,平均55.5岁。传统PLIF术组男28例,女22例,年龄47～70岁,平均53.0岁。结果采用日本骨科协会评分(Japanese orthopaedic association,JOA)、视觉模拟疼痛评分(visual analogue scale,VAS)及影像学检查评价治疗的效果。术后随访12～50个月,平均26.5个月。改良PLIF组和传统PLIF组JOA评分术前分别为(6.5±1.3)分、(6.5±1.2)分;术后3个月分别为(12.6±2.3)分、(12.4±2.1)分;末次随访分别为(13.1±1.7)分、(13.2±1.6)分。手术前与术后3个月和末次随访时JOA评分各组有统计学差异(P<0.05),3个月与末次随访之间各组无统计学差异(P>0.05)。VAS评分术前分别为(7.9±1.6)分、(7.8±1.6)分;术后3个月分别为(2.5±1.2)分、(2.5±1.1)分;末次随访分别为(1.2±0.1)分、(1.2±0.2)分;术前和术后3个月及末次随访之间各组有统计学差异(P<0.05),术后3个月和末次随访之间各组有统计学差异(P<0.05)。两组住院日无差异性,而手术时间、术中出血量有差异性。影像学检查内固定均无松动和折断,椎间融合良好。2例改良PLIF术病例和3例传统PLIF术病例并发脑脊液漏,对症引流治愈。结论改良PLIF术治疗腰椎管狭窄症可以获得传统PLIF术相同的临床效果,但具有手术时间短、术中出血量少等优点。

Treatment of Lumbar Spinal Stenosis with Improved PLIF Surgery

Objective To evaluate the clinical outcomes of treating lumbar spinal stenosis with improved PLIF and traditional PLIF surgery.Methods From Sep 2008 to Aug 2010.Each 50 cases with Lumbar spinal stenosis which monitored treated surgically with improved PLIF and traditional PLIF surgery were reviewed retrospectively.The results were evaluated with Japanese Orthopedic Association score(JOA) and VAS,patients′ subjective satisfaction degree.Complications and radiographic findings were also reviewed.Results All cases were followed up for an average period of 26.5 months from(12 months to 50 months).The JOA scores of improved PLIF and traditional PLIF were(6.5±1.3),(6.5±1.2) before surgery;(12.6±2.3) and(12.4±2.1) 3 months after surgery;(13.1±1.7),(13.2±1.6) at the end of follow-up.JOA score before surgery were significantly different from that of 3 month after surgery and end of follow-up(P<0.05).There was not significant betweem the 3-month follow-up and last follow-up.(P>0.05).Low back pain VAS scores before surgery were(7.9±1.6),(7.8±1.6),(2.5±1.2),(2.5±1.1) 3 month after surgery,(1.2±0.1),(1.2±0.2) at the end of follow-up.The VAS score for low back pain and leg pain 3 months after operation and last follow-up showed significant difference compared with preoperative ones(P<0.05).The two groups were significantly different of operation time and surgical bleeding,but length of in hospital time was not.No loosen or fracture of fixation were found.Interbody fusion was good.Complications included dural tear improved PLIF in 2cases and traditional PLIF in 3 cases.Conclusion Improved PLIF has the similar clinical outcome for Lumbar spinal stenosis in compared with traditional PLIF but it minimize blood loss,shorten the operation time.