改良PLIF术治疗原位复发性腰椎间盘突出症

目的 探讨改良PLIF术治疗原位复发性腰椎间盘突出症的适应证和临床疗效.方法 对2005年3月至2009年9月使用改良PLIF术和传统PLIF术治疗原位复发性腰椎间盘突出症患者资料进行回顾性研究分析,采用JOA评分、VAS评分及影像学检查评价治疗效果.结果 使用改良PLIF术62例患者,术后随访12-48个月,平均27.5个月.使用传统PLIF术30例患者,术后随访12-42个月,平均25个月.改良PLIF组和传统PLIF组JOA评分术前分别为(6.45±1.25),(6.50±1.26);术后3个月分别为(12.55±2.33),(12.55±2.30);末次随访分别为(13.03±1.90),(13.87±1.56).手术前与术后3个月和末次随访时JOA评分两组有统计学差异(P<0.05),3个月与末次随访之间两组无统计学差异(P>0.05).VAS评分术前分别为(7.90±1.62),(7.87±1.62);术后3个月分别为(2.54±1.32),(2.53±1.28);末次随访分别为(1.09±0.27),(1.11±0.18);术前和术后3个月及末次随访之间两组有统计学差异(P<0.05),术后3个月和末次随访之间两组有统计学差异(P<0.05).所有患者影像学检查内固定无松动和折断,椎间融合良好.改良组3例并发脑脊液漏,对症引流治愈.1例双下肢肌力下降患者,术后下肢肌力改善不明显,行理疗处理.传统组2例并发脑脊液漏,对症引流治愈.手术时间和出血量两组有差异性,改良组明显优于传统组;而住院时间无差异性.结论 改良PLIF术治疗原位复发性腰椎间盘突出症可以获得传统PLIF术相同的临床效果,但具有手术损伤小、时间短、术中出血量少等优点.

The treatment of recurrent lumbar disc herniation in situ with improved PLIF

Objective To explore the indications and clinical effects of improved PLIF in the treatment of recurrent lumbar disc herniation in situ. Methods The data of patients with recurrent lumbar disc herniation in situ and treated with improved PLIF and traditional PLIF from March 2005 to September 2009 were studied and analyzed retrospectively and the therapeutic effects were assessed by Japanese orthopaedic association（JOA） score, visual analogue scale（VAS） score and imaging study. Results 62 cases with improved PLIF were followed up from 12 to 48 months. The mean follow-up time was 27.5 months. 30 cases with traditional PLIF were all followed up for an average of 25 months （range;12-42 months）. Preoperatively, the JOA scores of improved PLIF and traditional PLIF were 6.45±1.25 and 6.50±1.26. 3 months after surgery were 12.55±2.33 and 12.55±2.30. In the latest follow-up were 13.03±1.90 and 13.87±1.56. As for JOA score, significant differences existed in each group preoperatively, 3 months postoperatively and in the latest follow-up （P〈0.05）. No significant difference existed in each group comparing 3 months postoperatively and the latest follow-up （P〉0.05）. Low back pain VAS score before surgery were 7.90±1.62 and 7.87±1.62, 3 months after surgery were 2.54±1.32 and 2.53±1.28, and in the latest follow-up were 1.09±0.27 and 1.11±0.18. As for VAS score, significant differences existed in each group preoperatively, 3 months postoperatively and in the latest follow-up （P〈0.05）. Significant differences existed in each group comparing 3 months postoperatively and in the latest follow-up （P〈0.05）. According to the imaging study of all the patients, the internal fixation did not loosen or fracture and the interbody fusion was good. Complications including cerebrospinal leak in 3 cases with improved PLIF and in 2 cases with traditional PLIF were treated with drainage cure symptomatically. There was no significant improvement of lower limb muscle strength postoperatively for the 1 patient of lower limb muscle strength decline with improved PLIF, who was then given physiotherapy treatment. There were differences in operative time and amount of surgical bleeding between the 2 groups and the improved group was significantly better than the traditional one. However, the lengthes of stay were almost the same. Conclusions There are the same clinical effects of improved PLIF in the treatment of recurrent lumbar disc herniation in situ as that of traditional PLIF. However, improved PLIF has such advantages as less surgical injury, shorter operative time, less surgical bleeding and so on.