显微镜下微创保留后方韧带复合体及腰椎置钉融合治疗腰椎退变性疾病

摘要

背景:在后路腰椎融合过程中切除后方韧带复合体,可能会影响相邻节段的运动和负荷规律,导致相邻节段出现术后失稳,使其成为邻近节段退变的重要因素之一.目的:探讨显微镜下微创保留后方韧带复合体的后路腰椎置钉融合治疗腰椎退变性疾病的可行性.方法:纳入36例单节段腰椎退变性疾病患者,其中17例进行显微镜下保留后方韧带复合体的后路腰椎融合手术,同时以螺钉固定,作为试验组;另19例进行切除后方韧带复合体的传统后路腰椎融合手术,同时以螺钉固定,作为对照组.治疗前及治疗后3个月,评估患者目测类比评分与Oswestry功能障碍指数;随访期间,X射线观察邻近节段退变情况.结果与结论:两组治疗后3个月的目测类比评分与Oswestry功能障碍指数均明显低于治疗前(P＜0.01),试验组治疗后3个月的目测类比评分与Oswestry功能障碍指数明显低于对照组(P＜0.01);随访期间,试验组2例出现邻近节段退变,对照组8例出现邻近节段退变,X射线片显示内固定稳定,无椎弓根钉松动、断裂或脱出等并发症发生;结果表明显微镜下微创保留后方韧带复合体的后路腰椎置钉融合,可有效缓解腰椎退变患者的疼痛和功能障碍,减少邻近节段退变的发生.%BACKGROUND:Removing the posterior ligamentous complexes during posterior lumbar interbody fusion (PLIF) may influence motion and load bearing characteristics of the adjacent segments,contributing to the postoperative instability at the adjacent segment,which is one of the important factors for adjacent segment degeneration.OBJECTIVE:To evaluate the clinical effectiveness of the PLIF plus screw implantation preserving posterior ligamentous complexes under microscope.METHODS:Thirty-six patients with single-level lumbar degenerative disease were enrolled,which were allotted to experimental (n=17) and control (n=1 9) groups,followed by treated with PLIF plus screw implantation preserving posterior ligamentous complexes,and traditional PLIF plus screw implnatation,respectively.The Visual Analogue Scale scores and Oswestry Dysfunction Index at baseline and postoperative 3 months were assessed.The adjacent segment degeneration was observed through radiology during follow-up.RESULTS AND CONCLUSION:The Visual Analogue Scale and Oswestry Dysfunction Index scores in the two groups were significantly lower than those before treatment (P ＜ 0.01),and the postoperative scores in the experimental group were significantly lower than those in the control group (P ＜ 0.01).The adjacent segment degeneration occurred in two cases in the experimental group and 8 cases in the control group during follow-up.Radiology revealed that the internal fixative was stable,none of screw loosening,rupture or pullout.These results suggest that PLIF plus screw implantation with posterior ligamentous complexes can effectively relieve the pain and dysfunction in the lumbar degenerative patients,and reduce the incidence of adjacent segment degeneration.