CAJ | 학술논문

目的比较改良腰椎后路椎间融合术(posterior lumbar interbody fusion,PLIF)与传统PLIF治疗腰椎管狭窄症的临床疗效. 方法回顾性研究2007年10月-2011年1月收治的腰椎退行性改变所致椎管狭窄症患者47例,均为L4,5单节段椎管狭窄,均有典型间歇性跛行及单或双下肢麻木疼痛.将47例患者采用抽签法随机分为A、B两组.A组24例,其中男10例,女14例；年龄47 ～66岁,平均52岁；病程9～ 23个月,平均13个月.B组23例,其中男8例,女15例；年龄49 ～67岁,平均53岁；病程6～22个月,平均11.5个月.A组采用棘突回植结合椎管“H”形植骨重建脊柱后柱结构并行椎间融合的改良PLIF手术；B组采用去除脊柱后部结构减压并行椎间融合的传统式PLIF手术.采用腰椎功能障碍指数(Oswestry disability index,ODI)评定术后两组患者腰部功能康复状况,并分析治疗效果. 结果 A组和B组的手术时间分别为(190±15.66) min和(170±11.32) min,术中失血量为(980±35.58) ml和(879±21.25)ml(P ＞0.05).术后患者随访12 ～28个月,平均20个月.疗效评定:A组优19例,良3例,可2例,差0例,优良率为88％；B组优13例,良4例,可4例,差2例,优良率为74％ (P ＜0.05).A组ODI分数及术后症状改善率均优于B组(P＜0.05). 结论棘突回植结合椎管“H”形植骨重建脊柱后柱结构的改良PLIF术式是治疗腰椎管狭窄症较为理想的术式,值得临床推广应用.
목적 비교개량요추후로추간융합술(posterior lumbar interbody fusion,PLIF)여전통PLIF치료요추관협착증적림상료효. 방법 회고성연구2007년10월-2011년1월수치적요추퇴행성개변소치추관협착증환자47례,균위L4,5단절단추관협착,균유전형간헐성파행급단혹쌍하지마목동통.장47례환자채용추첨법수궤분위A、B량조.A조24례,기중남10례,녀14례；년령47 ～66세,평균52세；병정9～ 23개월,평균13개월.B조23례,기중남8례,녀15례；년령49 ～67세,평균53세；병정6～22개월,평균11.5개월.A조채용극돌회식결합추관“H”형식골중건척주후주결구병행추간융합적개량PLIF수술；B조채용거제척주후부결구감압병행추간융합적전통식PLIF수술.채용요추공능장애지수(Oswestry disability index,ODI)평정술후량조환자요부공능강복상황,병분석치료효과. 결과 A조화B조적수술시간분별위(190±15.66) min화(170±11.32) min,술중실혈량위(980±35.58) ml화(879±21.25)ml(P ＞0.05).술후환자수방12 ～28개월,평균20개월.료효평정:A조우19례,량3례,가2례,차0례,우량솔위88％；B조우13례,량4례,가4례,차2례,우량솔위74％ (P ＜0.05).A조ODI분수급술후증상개선솔균우우B조(P＜0.05). 결론 극돌회식결합추관“H”형식골중건척주후주결구적개량PLIF술식시치료요추관협착증교위이상적술식,치득림상추엄응용.
Objective To compare the clinical outcomes of modified and traditional posterior lumbar interbody fusion (PLIF) in treatment of lumbar spinal stenosis.Methods A retrospective review was made on 47 patients who sustained monosegmental L4.5 stenosis due to lumbar degenerative revise and characterized by typical intermittent claudication and single or both limb numbness and pain.The patients were randomly allocated to Group A and Group B using the lottery method.Group A (n =24) consisted of 10 males and 14 females at mean age of 52 years (range,47-66 years) and the course of disease averaged 13 months (range,9-23 months).Group B (n =23) contained 8 males and 15 females at mean age of 53 years (range,49-67 years) and the course of disease averaged 11.5 months (range,6-22months).Modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction and interbody fusion was performed in Group A.Traditional PLIF,namely posterior spinal decompression and interbody fusion,was performed in Group B.Waist function rehabilitation after surgery of the patients in the two groups was assessed using the Oswestry disability index (ODI) and postoperative results were analyzed.Results There were no significant differences between Groups A and B regarding the operation time [(1 90 ± 15.66) min vs (170 ± 11.32) min] and intraoperative blood loss [(980 ± 35.58) ml vs (879 ± 21.25) ml] (P ＞ 0.05).Mean period of follow-up was 20 months (range,12-28 months).Postoperative results in Group A were graded as excellent in 19cases,good in three,fair in two and poor in zero,with excellence rate of 88％.While in Group B,the results were excellent in 13 cases,good in four,fair in four and poor in two,with excellence rate of 74％(P ＜ 0.05).ODI score and symptom improvement rate after operation were better in Group A than in Group B (P ＜ 0.05).Conclusion The modified PLIF including spinous process replantation combined with canal H-shaped bone grafting for posterior column reconstruction is relatively an ideal surgical technique for treatment of lumbar spinal stenosis and deserves wide promotion.