[1]董永涵,董玉珍,赵　斌,等.保留后方韧带复合体后路腰椎椎间融合术对术后腰椎邻近节段退变的影响[J].新乡医学院学报,2019,36(3):242-245.[doi:10.7683/xxyxyxb.2019.03.009]
　DONG Yong-han,DONG Yu-zhen,ZHAO Bin,et al.Effect of posterior ligament complex preservation on adjacent segmental degeneration of lumbar spine after posterior lumbar interbody fusion[J].Journal of Xinxiang Medical University,2019,36(3):242-245.[doi:10.7683/xxyxyxb.2019.03.009]
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保留后方韧带复合体后路腰椎椎间融合术对术后腰椎邻近节段退变的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年3
页码:
242-245
栏目:
临床研究
出版日期:
2019-03-05

文章信息/Info

Title:
Effect of posterior ligament complex preservation on adjacent segmental degeneration of lumbar spine after posterior lumbar interbody fusion
作者:
董永涵; 董玉珍; 赵　斌; 李爱国; 路　坦
(新乡医学院第一附属医院骨外二科，河南　卫辉　453100)
Author(s):
DONG Yong-han; DONG Yu-zhen; ZHAO Bin; LI Ai-guo; LU Tan
(Department of Orthopedics,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
腰椎间盘突出症; 后路腰椎椎间融合术; 后方韧带复合体; 邻近节段退变
Keywords:
lubar intervertebral disc protrusion; posterior lumbar interbody fusion; posterior ligament complex; adjacent segmental degeneration
分类号:
R681.5+7
DOI:
10.7683/xxyxyxb.2019.03.009
文献标志码:
A
摘要:
目的　探讨保留后方韧带复合体(PLC)的后路腰椎椎间融合术(PLIF)对术后腰椎邻近节段退变（ASD）的影响。方法　选择2014年1月至2016年1月新乡医学院第一附属医院骨外二科因第4~5腰椎椎间盘突出行PLIF的100例患者为研究对象，根据术式分为观察组和对照组，每组50例。观察组患者行保留PLC的改良PLIF，对照组患者行传统PLIF。2组患者均于术前及术后12个月摄腰椎正侧位、动力位X线片，根据术后症状有无复发及影像学检查结果评估术后腰椎ASD情况。应用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评估2种术式的临床疗效。结果　2组患者术前VAS评分及ODI比较差异均无统计学意义(P>0.05)。术后12个月，2组患者VAS评分及ODI均显著低于术前(P<0.05)；但2组患者VAS评分及ODI比较差异无统计学意义(P>0.05)。术后12个月，观察组患者共发生ASD 8例（16.0%），其中影像学退变7例(14.0%),症状学退变1例(2.0%）；对照组患者共发生ASD 28例（56.0%），其中影像学退变20例(40.0%)，症状学退变8例(16.0%)；观察组患者ASD发生率及影像学退变率、症状学退变率均显著低于对照组（χ2=15.668、8.547、4.396，P<0.05）。观察组8例退变患者中，头端退变5例(62.5%)，尾端退变3例(37.5%)，观察组头端退变与尾端退变所占比例比较差异无统计学意义(χ2=0.543，P>0.05)。对照组28例退变患者中，头端退变21例(75.0%)，尾端退变7例(25.0%)，对照组头端退变所占比例显著高于尾端退变所占比例 (χ2=9.722，P<0.05)。结论　改良PLIF与传统PLIF的临床疗效相当，但保留PLC的改良PLIF可明显降低术后ASD发生率，尤其是头端退变的发生。
Abstract:
Objective　To investigate the effect of posterior ligament complex(PLC) preservation on adjacent segmental degeneration (ASD) of lumbar spine after posterior lumbar interbody fusion(PLIF).Methods　A total of 100 patients with 4-5 lumbar intervertebral disc herniation treated by PLIF in the First Affiliated Hospital of Xinxiang Medical University from January 2014 to January 2016 were selected as subjects.,The patients were divided into observation group and control group according to the operation method,50 cases in each group.The patients in the observation group were treated with modified PLIF with preservation of PLC,while the patients in the control group were treated with traditional PLIF.The positive-lateral and dynamic X-ray films of lumbar spine were taken before and 12 months after operation in the two groups.The postoperative ASD was assessed according to the recurrence of symptoms and imaging findings.The clinical effect of the two surgical methods was evaluated by visual analogue scales (VAS) and Oswestry disability index (ODI).Results　There was no significant difference in the preoperative VAS score and ODI between the two groups (P>0.05).The VAS score and ODI at 12 months after operation were significantly lower than those before operation in the two groups (P<0.05).However,there was no significant difference in the VAS score and ODI between the two groups at 12 months after operation (P>0.05).At 12 months after operation,there were 8 cases (16.0%) of ASD in the observation group,including 7 cases (14.0%) of imaging degeneration and 1 case (2.0%) of symptomatic degeneration.There were 28 cases (56.0%) of ASD in the control group,including 20 cases (40.0%) of imaging degeneration and 8 cases (16.0%) of symptomatic degeneration.The incidence of ASD,imaging degeneration rate and symptomatic degeneration rate in the observation group were significantly lower than those in the control group (χ2=15.668,8.547,4.396;P<0.05).Among the 8 patients with ASD in the observation group,5 cases (62.5%) had degeneration of the headend,3 cases (37.5%) had degeneration of the tail,there was no statistically significant difference in the incidence of headend and tail degeneration (χ2=0.543，P>0.05).Among the 28 patients with ASD in the control group,21 cases (75.0%) had degeneration of the headend,7 cases (25.0%) had degeneration of the tail,The proportion of headend degeneration was significantly higher than that of tail degeneration (χ2=9.722,P<0.05).Conclusion　The clinical effect of modified PLIF is similar to that of traditional PLIF in the treatment of lubar intervertebral disc protrusion,but the modified PLIF with preservation of PLC can significantly reduce the incidence of ASD (especially headend degeneration) after operation.

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更新日期/Last Update: 2019-03-05