摘要
目的比较前路腰椎椎间融合术(ALIF)与后路腰椎椎间融合术(PLIF)治疗椎间盘源性腰痛的疗效。方法回顾性分析2010年1月-2015年12月分别接受ALIF(31例)和PLIF(34例)治疗的退行性椎间盘源性腰痛患者的临床资料,比较2组患者术中出血量、术后症状无缓解例数、恢复工作时间及并发症发生情况,术前和术后6周、3个月、1年疼痛视觉模拟量表(VSA)评分、Oswestry功能障碍指数(ODI)及融合率。结果所有手术顺利完成,所有患者随访≥1年。ALIF组术中出血量、术后症状无缓解例数低于PLIF组,恢复工作时间长于PLIF组,术后6周、3个月、1年腰痛VAS评分和ODI改善较PLIF组显著,术后6周、3个月下肢痛VAS评分改善较PLIF组显著,差异均有统计学意义(P<0.05);术后1年下肢痛VAS评分、术后融合率组间差异无统计学意义(P>0.05)。术后3例患者(ALIF组1例、PLIF组2例)出现切口愈合不佳,经换药后好转。PLIF组1例硬膜撕裂于术中修补,术后未出现脑脊液漏;1例持续存在神经根刺激症状,经复查可能为1枚椎弓根螺钉位置偏内所致,经非手术治疗3个月症状缓解。ALIF组1例发生难治性呃逆,术后15 d缓解。2组均无内固定松动、断裂等并发症发生。结论治疗椎间盘源性腰痛,ALIF在改善症状方面更具优势,术中出血量更小。
Objective To compare the efficiency of anterior lumbar interbody fusion(ALIF)and posterior lumbar interbody fusion(PLIF)in the treatment of discogenic lumbar pain.Methods From January 2010 to December 2015,the clinical data of patients with degenerative discogenic low back pain treated with ALIF(31 cases)and PLIF(34 cases)were analyzed retrospectively.The intraoperative blood loss,number of cases without remission of symptoms,recovery time,complications,preoperative and postoperative 6 weeks,3 months and 1 year pain visual analog scale(VSA)score,Oswestry disability index(ODI)and fusion rate were compared between the 2 groups.Results All the operations were successfully completed and all the patients were followed up for≥1 year.In ALIF group,the intraoperative blood loss and case number without remission of symptoms were lower than those in PLIF group;the recovery time was longer than that in PLIF group;VAS score of low back pain and ODI improved significantly in 6 weeks,3 months and 1 year after operation compared with PLIF group;VAS score of lower limb pain improved significantly in 6 weeks and 3 months after operation compared with PLIF group;and the differences were statistically significant(P<0.05).The VAS score of lower limb pain and fusion rate at postoperative 1 year showed no statistically significant difference between the 2 groups(P>0.05).Three patients(1 in ALIF group and 2 in PLIF group)showed poor incision healing,which was improved after dressing change.In PLIF group,1 case of dural tear was repaired intraoperatively,with no cerebrospinal fluid leakage occurred postoperatively;1 case had persistent nerve root stimulation symptoms,which may be caused by the deviation of the pedicle screw position,and the symptoms were relieved after 3 months of non-surgical treatment.In ALIF group,intractable hiccup in 1 case was relieved 15 d after operation.No complications such as loosening and fracture of internal fixation occurred in the 2 groups.Conclusion ALIF is more advantageous in the treatment of discogenic lower back pain,with less intraoperative blood loss.
作者
刘彪
陆慧
LIU Biao;LU Hui(Department of Orthopaedics,Jiangjin District Central Hospital of Chongqing,Chongqing 402260,China)
出处
《脊柱外科杂志》
2019年第6期400-403,408,共5页
Journal of Spinal Surgery
关键词
腰椎
椎间盘
腰痛
脊柱融合术
Lumbar vertebrae
Intervertebral disk
Low back pain
Spinal fusion
