摘要
目的探讨医用交联高分子透明质酸钠凝胶预防腰椎术后硬膜外粘连的疗效。方法选择我院治疗的腰椎退变性疾病患者92例，按手术及处理方法分为A组：腰后路减压植骨内固定术＋交联高分子透明质酸钠凝胶组，52例；B组：腰后路减压植骨内固定术＋生理盐水组，40例。两组均采用腰后路经椎间孔椎体间融合术（TLIF），A组在减压处硬膜囊及神经根处予以交联高分子透明质酸钠凝胶处理，B组予以生理盐水。分析比较两组的手术时间、术中出血量、术后引流量。临床疗效比较两组术前、术后及末次随访时腰痛和下肢活动疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评分。影像学评价采用腰椎磁共振成像（MRI）测量比较术前及随访MRI手术节段椎管矢状径、硬膜囊面积。结果92例患者均顺利完成手术，术中无明显并发症；两组患者一般资料无明显差异，两组患者手术时间（t=1.736, P=0.086）、术中出血量（t=1.084, P=0.281）、术后引流量（t=0.816, P=0.417）差异无统计学意义。所有患者均获随访；两组术后、末次随访时VAS、ODI评分均较术前差异有统计学意义；A组术后、末次随访下肢疼痛VAS评分[（2.50±1.21）、（2.21±1.16）分]与B组[（2.98±0.95）、（2.70±1.07）分]比较差异有统计学意义，而腰痛VAS评分两组差异无统计学意义；两组术后、末次随访ODI评分差异无统计学意义。两组术前椎管矢状径、硬膜囊面积差异无统计学意义，A组术后随访MRI椎管矢状径[（15.52±0.98） mm]与B组[（15.13±1.07） mm]差异无统计学意义（t=1.841，P=0.069），A组术后随访MRI硬膜囊面积[（181.58±8.19） mm^2]优于B组[（169.03±6.02） mm^2]，差异有统计学意义（t=0.814，P=0.000）。结论腰后路减压植骨内固定术联合减压处应用交联高分子透明质酸钠凝胶比单纯减压手术能更好的预防椎管内粘连，减轻临床症状，减少术后下肢疼痛，具有较好的临床疗效。
Objective To evaluate the preventive effect of medical cross-linked high-molecular-weight sodium hyaluronate gel for epidural scar adhesion after lumbar surgery.Methods Atotal of 92 patients were divided into 2 groups. Fifty-two patients in group A underwent decompression surgery combined with medical sodium hyaluronate gel. Forty patients in group B underwent only decompression surgery. The patients were given posterolateral fixation with pedicle screw and decompression, interbody fusion through posterior lumbar interbody fusion （TLIF） with or without the use of medical sodium hyaluronate gel. Operating time, blood loss and volume of drainage after operation were compared between two groups. Visual analogue scale （VAS） and Oswestry dysfunction index （ODI） in lower extremity pain were applied to evaluate the therapeutic effect. The radius vector of sagittal spinal canal and the thecal sac cross sectional area were measured by magnetic resonance imaging （MRI）.Results All patients underwent surgery safely without severe complications occurred. There was no significant difference in general materials and operation time （t=1.736, P=0.086）, blood during operation （t=1.084, P=0.281）, volume of drainage after operation （t=0.816, P=0.417） between two groups. As compared with preoperative parameters, the scores of VAS in back pain and lower limb pain and ODI were decreased significantly after surgery and at the final follow-up in both two groups. There was significant difference in lower limb VAS score between two groups, but there was no significant difference between two groups in ODI scores and back pain VAS score. There was no significant difference between Group A [（15.52±0.98） mm] and B [（15.13±1.07） mm] in L4/5 sagittal spinal canal after surgery （t=1.841, P=0.069）. There was significant difference between Group A [（181.58±8.19） mm2] and B [（169.03±6.02） mm2] in the thecal sac cross sectional area （t=0.814, P=0.000）.Conclusion Lumbar decompression surgery combined with medical sodium hyaluronate gel had a beter effect than simple operation. It can provide better prevention for epidural adhesions and more satisfactory clinical effects.
出处
《中华实验外科杂志》
CSCD
北大核心
2017年第7期1239-1242,共4页
Chinese Journal of Experimental Surgery
关键词
腰椎退行性疾病
手术
交联透明质酸钠
硬膜外粘连
预防
Lumbar degeneration disease
Surgery
Medical sodium hyaluronate gel
Epidural adhesion
Prevention
