摘要
目的探讨经椎间孔入路椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗弥漫性特发性骨质增生症(diffuse idiopathic skeletal hyperostosis,DISH)合并腰椎管狭窄症(lumbar spinal stenosis,LSS)患者的临床疗效。方法回顾性分析2010年1月至2016年6月接受TLIF手术治疗33例伴DISH的LSS患者病历资料,男15例,女18例;年龄(65.1±11.2)岁(范围50~70岁);腰椎固定节段(1.45±0.42)个(范围1~3个)。选取同期性别、年龄(范围3岁内)及手术固定节段匹配不伴DISH的33例LSS患者作为对照,年龄(67.3±13.6)岁(范围50~70岁)。临床疗效评估采用Oswestry功能障碍指数(Oswestry disability index,ODI)及腰部、下肢疼痛视觉模拟评分(visual analogue scale,VAS)。腰椎矢状位测量参数包括腰椎前凸角、腰椎局部前凸角及下腰椎前凸角,采用Pfirrmann分级评估术前椎间盘退变程度,记录术后融合器沉降发生情况。结果两组患者年龄、术前骨密度、手术时间、术中出血量、术中融合节段数及术后随访时间的差异均无统计学意义(P>0.05)。DISH组患者术前椎间盘Pfirrmann分级为(3.82±0.64)分,明显高于非DISH组(3.20±0.95)分(t=3.109,P=0.002),而腰椎前凸角及下腰椎前凸角明显低于非DISH组(腰椎前凸角37.4°±8.5°vs.45.2°±12.2°,t=3.013,P=0.003;下腰椎前凸角18.3°±3.9°vs.21.9°±5.4°,t=3.104,P=0.002)。两组患者术后腰椎前凸角较术前均明显增加,但随访期间DISH组腰椎前凸角、腰椎局部前凸角及下腰椎前凸角均有明显矫正丢失。末次随访时DISH组腰椎前凸角(43.6°±9.7°vs.50.1°±10.2°,t=2.652,P=0.010)、腰椎局部前凸角(17.4°±6.5°vs.22.7°±7.2°,t=3.138,P=0.002)及下腰椎前凸角(19.1°±4.7°vs.22.9°±5.2°,t=2.540,P=0.013)均明显低于非DISH组。末次随访时DISH组中12例发生融合器沉降,发生率明显高于非DISH组(36.3%vs.12.1%,χ2=5.280,P=0.022)。末次随访时两组患者ODI及腰部、下肢VAS评分较术前均有明显改善(P<0.05),但DISH组患者腰痛VAS评分明显高于非DISH组(t=2.862,P=0.005)。结论相比非DISH的LSS患者,伴有DISH的LSS患者TLIF术后易发生融合器沉降及腰椎前凸角的矫正丢失;且末次随访时伴DISH的LSS患者腰痛VAS评分明显高于非DISH组。
Objective To evaluate the outcomes of transforaminal lumbar interbody fusion(TLIF)for patients with lumbar spinal stenosis(LSS)and diffuse idiopathic skeletal hyperostosis(DISH).Methods This study recruited 33 patients(15 male and 18 female)with LSS and DISH who underwent TLIF surgery from January 2010 to July 2018.The mean age was 65.1±11.2 years old and the instrumented segments averaged 1.45±0.42 levels.Another group of LSS patients without DISH were well matched to the DISH group at a 1∶1 ratio in terms of age,sex,and instrumented levels.Lumbar lordosis,local lordosis as well as lowerlumbarlordosis were measured on X-ray taken before and after surgery.According to Pfirrmann's classification,the degree of preoperative disc degeneration was evaluated on preoperative MRI,and the incidence of postoperative fusion cage subsidence was recorded during follow-up.Oswestry disability index(ODI)was used to evaluate the lumbar function and visual analogue scale(VAS)scores for low back pain and leg pain were used to evaluate the quality of life.Results There were no significant difference between two groups in terms of age,bone mineral density,operative time,postoperative bleeding volume,fusion levels and postoperative follow-up time.Compared with the non-DISH group(3.20±0.95),the DISH group had higher degeneration disc according to Pfirrmann's classification(3.82±0.64)(t=3.109,P=0.002),lower lumbar lordosis(37.4°±8.5°vs.45.2°±12.2°,t=3.013,P=0.003),and lower lower lumbar lordosis(18.3°±3.9°vs.21.9°±5.4°,t=3.104,P=0.002).After TLIF surgery,lumbar lordosis was significantly improved in both groups.During follow-up,notable correction loss was noted in DISH group in terms of lumbar lordosis(43.6°±9.7°vs.50.1°±10.2°,t=2.652,P=0.010),lower lumbar lordosis(19.1°±4.7°vs.22.9°±5.2°,t=2.540,P=0.013)as well as local lumbar lordosis(17.4°±6.5°vs.22.7°±7.2°,t=3.138,P=0.002).Moreover,these above value in the DISH group were significantly lower than those in the non-DISH group.At the latest follow-up,12 patients in the DISH group were identified with cage subsidence,which were significantly higher than in the non-DISH group(36.3%vs.12.1%,χ2=5.280,P=0.022).Till the latest follow-up,both groups had considerable improvement of the ODI score,back pain and leg pain VAS score.However,the back pain VAS scores in the DISH group were significantly higher than that in the non-DISH group(t=2.862,P=0.005).Conclusion Compared with LSS patients without DISH,LSS patients with DISH are more likely to have cage subsidence and loss of correction of lumbar lordosis angle after TLIF surgery.Moreover,the VAS score of low back pain in LSS patients with DISH was lower than those without DISH.
作者
闫煌
封层
刘臻
孙旭
邱勇
朱泽章
Yan Huang;Feng Ceng;Liu Zhen;Sun Xu;Qiu Yong;Zhu Zezhang(Department of Spine Surgery,Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China;Department of Orthopaedics(I),Qiandongnan State People′s Hospital,Kaili 556000,China;Department of Spine Surgery,Tenth People's Hospital of Tongji University,Shanghai 200120,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2021年第21期1528-1535,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金青年项目(81702234)。
关键词
骨肥厚
弥漫性特发性骨骼
腰椎
椎管狭窄
脊柱融合术
Hyperostosis,diffuse idiopathic skeletal
Lumbar vertebrae
Spinal stenosis
Spinal fusion
