【摘要】：[目的]對比椎間孔鏡(PTED)聯(lián)合經皮棘突間動態(tài)固定(In-Space)與常規(guī)融合內固定(PLIF)治療腰椎退行性疾病的臨床療效。[方法]選取2012年1月~2013年1月本科收治的65例病例,電腦隨機將31例患者分入In-Space組,34例患者分入PLIF組,隨訪12個月,比較兩組手術時間、術中出血量、住院天數、并發(fā)癥發(fā)生率等。分別在術前、術后1個月、術后3個月、術后6個月、術后12個月進行視覺疼痛模擬評分(VAS)評分、Oswsstry功能障礙指數(ODI)評價手術效果。于各隨訪時間點分別攝腰椎正、側位及動力位X線片,測量手術節(jié)段及上鄰節(jié)段腰椎活動度(ROM),評價末次隨訪腰椎穩(wěn)定性變化。[結果]In-Space組出血量、住院天數明顯少于PLIF組(P0.01),兩組手術時間差異無統(tǒng)計學意義(P0.05)。In-Space組和PLIF組并發(fā)癥發(fā)生率分別為6.45%(2/31)和26.47%(9/34),差異具有統(tǒng)計學意義(P0.05)。兩組術后腰腿痛VAS評分、ODI指數均較術前明顯改善(P0.01),但PLIF組術后1個月及3個月腰痛VAS評分高于In-Space組(P0.05)。In-Space組手術節(jié)段、上鄰節(jié)段ROM術前與末次隨訪相比差異無統(tǒng)計學意義(P0.05)。末次隨訪中,In-Space組手術節(jié)段ROM明顯大于PLIF組(P0.01),PLIF組上鄰節(jié)段ROM明顯大于術前(P0.05)及In-Space組(P0.05)。[結論]PTED聯(lián)合InSpace與PLIF治療腰椎退行性疾病均可取得滿意的臨床療效,但前者在完成良好減壓的同時,具有明顯的微創(chuàng)優(yōu)勢,且較好地維持脊柱活動度及穩(wěn)定性,是理想的微創(chuàng)手術方法。
[Abstract]:[objective] to compare the clinical effects of intervertebral foramen (PTED) combined with percutaneous dynamic interspinous process fixation (In-Space) and conventional fusion internal fixation (PLIF) in the treatment of lumbar degenerative diseases. [methods] from January 2012 to January 2013, 65 cases were randomly divided into In-Space group (34 cases) and PLIF group (34 cases). The two groups were followed up for 12 months. Incidence of complications, etc. Visual pain analogue score (VAS) and Oswsstry dysfunction Index (ODI) were performed before, 1 month, 3 months, 6 months and 12 months after operation respectively. Lumbar vertebrae were taken at different follow-up time points. The lumbar stability was evaluated by (ROM), for the lumbar motion of the operative segment and the upper adjacent segment of lumbar vertebrae. [results] the amount of bleeding in the In-Space group was significantly less than that in the PLIF group (P0.01). There was no significant difference in the operative time between the two groups (P0.05). The incidence of complications in the In-Space group and PLIF group was 6.45% (2 / 31) and 26.47% (9 / 34), respectively. The difference was statistically significant (P0.05). The VAS scores of lumbar and leg pain in the two groups were significantly improved compared with those before operation (P0.01), but the VAS scores in the PLIF group were higher than those in the In-Space group at 1 month and 3 months after operation (P0.05). There was no significant difference between the upper adjacent segment ROM and the last follow-up (P0.05). In the last follow-up, the ROM of the operative segment in the In-Space group was significantly higher than that in the PLIF group (P0.01). The ROM of the upper adjacent segment in the PLIF group was significantly higher than that in the preoperative group (P0.05) and the In-Space group (P0.05). [conclusion] PTED combined with InSpace and PLIF can achieve satisfactory clinical effect in the treatment of lumbar degenerative diseases, but the former has obvious advantages of minimally invasive operation, and maintains the range of spinal movement and stability in the treatment of lumbar degenerative diseases. It is an ideal method of minimally invasive surgery.
【作者單位】： 武警河南總隊醫(yī)院脊柱外科;
【分類號】：R687.3

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