椎间融合术治疗腰椎间盘突出症术后复发的临床研究
Clinical study on the treatment of postoperative recurrence of lumbar disc herniation with intervertebral fusion
郑连生 1李学民 1李玉龙1
作者信息
摘要
目的:探究不同椎间融合器(cage)治疗术后复发的腰椎间盘突出症(lumbardisc herniation,LDH)的临床疗效.方法:回顾性分析2019年1月至2021年1月142例行单纯椎间盘髓核摘除术后复发的LDH患者,均采用通道下联合固定并椎间融合术治疗,根据植入cage类型及数目不同分为单枚解剖组、2枚解剖组和单枚香蕉组.单枚解剖组 51 例,男 29 例,女 22 例;年龄 39～65(53.74±5.68)岁;身体质量指数(body mass index,BMI)18.62～28.13(22.08± 2.15)kg·m-2;手术与复发间隔时间0.5～4.0(2.7±0.8)年;L3,45例,L4,535例,L5S1 11例;植入单枚解剖型cage.2枚解剖组 46 例,男 25 例,女 21 例;年龄 37～66(54.15±6.02)岁;BMI 为 18.25～28.44(21.74±1.83)kg·m-2;手术与复发间隔时间0.5～5.0(2.7±0.9)年;L3,44例,L4,532例,L5S1 10例;植入2枚解剖型cage.单枚香蕉组45例,男22例,女23例;年龄 38～65(54.49±6.45)岁;BMI 为 18.85～28.20(21.63±1.59)kg·m-2;手术与复发间隔时间 0.5～5.0(2.6±1.0)年;L3,43 例,L4,536例,L5S16例;植入单枚香蕉型cage.观察并比较3组手术时间、术中出血量、切口长度、术后切口引流量、住院时间、并发症等情况;比较手术前后椎间隙高度、前凸曲度及术后椎间融合情况;分别于术前、术后1和6个月采用视觉模拟评分(visual analogue scale,VAS)和 Oswestry 功能障碍指数(Oswestry disability index,ODI)对腰部疼痛程度、腰椎功能进行临床疗效评价.结果:3组患者均获得至少6个月随访,无病例脱落.3组手术时间、术中出血量、切口长度、术后切口引流量、住院时间比较,差异无统计学意义(P＞0.05).2枚解剖组、单枚香蕉组术后6个月融合节段椎间隙高度[(11.08±1.78)mm、(10.95±1.62)mm]、前凸曲度[(12.05±1.86)°、(11.63±1.57)°],高于单枚解剖组(10.14±1.54)mm、(10.92±1.45)°,差异有统计学意义(P＜0.05);2枚解剖组、单枚香蕉组术后6个月椎间融合率(95.65％、95.56％),高于单枚解剖组(78.43％);3组术后1、6个月腰部VAS、ODI较术前下降(P＜0.05);3组并发症比较,差异无统计学意义(P＞0.05).结论:3种融合器治疗LDH术后复发均能取得显著效果,但植入2枚解剖型cage和单枚香蕉型cage更有助于维持LDH术后复发患者椎间隙高度、前凸曲度,可获得良好椎间融合效果.
Abstract
Objective To explore clinical effect of different intervertebral fusion devices(cage)in treating postoperative recurrent lumbar disc herniation(LDH).Methods One hundred and forty-two LDH patients with recurrence after simple in-tervertebral disc nucleus pulpoideectomy from January 2019 to January 2021 were retrospectively analyzed.All patients were treated with combined underchannel fixation and interbody fusion and divided into a single anatomical group,two-anatomical group and a single banana group according to types and numbers of implanted cage.There were 51 patients in a single anatom-ical group,included 29 males and 22 females,aged from 39 to 65 years old with an average of(53.74±5.68)years old;body mass index(BMI)ranged from 18.62 to 28.13 kg·m-2 with an average of(22.08±2.15)kg·m-2;the interval between operation and recurrence ranged from 0.5 to 4.0 years with an average of(2.7±0.8)years;5 patients with L3,4,35 patients with L4,5 and 11 patients with L5S1;a single anatomical cage was implanted.There were 46 patients in two-anatomical group,included 25 males and 21 females,aged from 37 to 66 years old with an average of(54.52±6.02)years old;BMI ranged from 18.25 to 28.44 kg· m-2 with an average of(21.74±1.83)kg·m-2;the interval between operation and recurrence ranged from 0.5 to 5.0 years with an average of(2.7±0.9)years;4 patients with L3,4,32 patients with L4,5 and 10 patients with L5S1;two-anatomical cages were im-planted.There were 45 patients in a single banana group,included 22 males and 23 females,aged from 38 to 65 years old with an average of(54.49±6.45)years old;BMI ranged from 18.85 to 28.20 kg·m-2with an average of(21.63±1.59)kg·m-2;the interval between operation and recurrence ranged from 0.5 to 5.0 years with an average of(2.6±1.0)years;3 patients with L3,4,36 patients with L4,5 and 16 patients with L5S1;a single banana cage was implanted.Operation time,intraoperative blood loss,incision length,postoperative incision drainage volume,hospital stay and complications among 3 groups were observed and compared.The height of intervertebral space before and after operation,curvature of lordosis and the postoperative interverte-bral fusion were compared.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate degree of lumbar pain and lumbar function before operation,1 and 6 months after operation,respectively.Results All patients among 3 groups were followed up at least 6 months,and no cases were fell out.There were no significant difference in operation time,in-traoperative blood loss,incision length,postoperative incision drainage volume and hospital stay among 3 groups(P＞0.05).At 6 months after operation,the height of intervertebral space in two-anatomical group and a single group were[(11.08±1.78)mm,(10.95±1.62)mm],curvature of lordosis were[(12.05±1.86)°,(11.63±1.57)°],which were higher than those in a sin-gle dissection group(10.14±1.54)mm,(10.92±1.45)°,and the difference were statistically significant(P＜0.05).The inter-body fusion rate between two-anatomical and a banana group(95.65％,95.56％)were higher than that in a single anatomical group(78.43％)at 6 months after operation(P＜0.05).VAS and ODI of lumbar among 3 groups were decreased at 1 and 6 months after operation(P＜0.05).There was no significant difference in complications among 3 groups(P＞0.05).Conclusion The three fusion devices could achieve significant results in treating postoperative recurrence of LDH,but the implantation of two-anatomical cage and a single banana cage are more helpful to maintain the height of intervertebral space and lordosis cur-vature of patients with postoperative recurrence of LDH,and obtain good intervertebral fusion results.
关键词
椎间融合器/腰椎间盘突出症/椎间隙高度/椎间融合Key words
Interbody fusion cage/Lumbar disc herniation/Intervertebral space height/Interbody fusion引用本文复制引用
基金项目
北京市卫生科技发展专项(2018-4-266)
出版年
2024
国家科技期刊平台
NSTL
万方数据