【摘要】：[目的]對(duì)比椎間孔鏡(PTED)聯(lián)合經(jīng)皮棘突間動(dòng)態(tài)固定(In-Space)與常規(guī)融合內(nèi)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(jī)將31例患者分入In-Space組,34例患者分入PLIF組,隨訪12個(gè)月,比較兩組手術(shù)時(shí)間、術(shù)中出血量、住院天數(shù)、并發(fā)癥發(fā)生率等。分別在術(shù)前、術(shù)后1個(gè)月、術(shù)后3個(gè)月、術(shù)后6個(gè)月、術(shù)后12個(gè)月進(jìn)行視覺(jué)疼痛模擬評(píng)分(VAS)評(píng)分、Oswsstry功能障礙指數(shù)(ODI)評(píng)價(jià)手術(shù)效果。于各隨訪時(shí)間點(diǎn)分別攝腰椎正、側(cè)位及動(dòng)力位X線片,測(cè)量手術(shù)節(jié)段及上鄰節(jié)段腰椎活動(dòng)度(ROM),評(píng)價(jià)末次隨訪腰椎穩(wěn)定性變化。[結(jié)果]In-Space組出血量、住院天數(shù)明顯少于PLIF組(P0.01),兩組手術(shù)時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)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(jì)學(xué)意義(P0.05)。兩組術(shù)后腰腿痛VAS評(píng)分、ODI指數(shù)均較術(shù)前明顯改善(P0.01),但PLIF組術(shù)后1個(gè)月及3個(gè)月腰痛VAS評(píng)分高于In-Space組(P0.05)。In-Space組手術(shù)節(jié)段、上鄰節(jié)段ROM術(shù)前與末次隨訪相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。末次隨訪中,In-Space組手術(shù)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(shù)前(P0.05)及In-Space組(P0.05)。[結(jié)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(shí),具有明顯的微創(chuàng)優(yōu)勢(shì),且較好地維持脊柱活動(dòng)度及穩(wěn)定性,是理想的微創(chuàng)手術(shù)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(duì)醫(yī)院脊柱外科;
【分類號(hào)】：R687.3

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