保留与不保留棘突韧带复合体的后路椎间融合比较△

Posterior lumbar interbody fusion with or without preservation of the spinous process- ligament complex for lumbar insta⁃ bility

摘要:

［目的］ 比较保留与不保留棘突-韧带复合体的后路椎间融合 （posterior lumbar interbody fusion, PLIF） 治疗腰椎不稳的临床效果。［方法］回顾性分析本院 2017 年 2 月—2020 年 12 月采用 PLIF 治疗腰椎不稳 84 例患者的临床资料。依据术前医患沟通结果，42 例采用保留棘突-韧带复合体，42 例术中常规切除棘突韧带复合体。比较两组围手术期、随访和影像资料。 ［结果］两组患者均顺利完成手术，无严重并发症。保留组术中失血量、术后引流量和术后切口疼痛 VAS 评分均显著优于常规组 （P<0.05），两组间手术时间、住院时间差异无统计学意义（P>0.05）。随时间推移，两组腰痛 VAS、腿痛 VAS、ODI 评分和 JOA 评分均显著改善（P<0.05）。末次随访时，保留组腰痛 VAS 评分和 JOA 评分显著优于常规组（P<0.05），而两组间腿痛 VAS 评分的差异无统计学意义（P>0.05）。随访过程中，保留组无术后持续综合征（postoperative persistent syndrome, POPS）发生，而常规组为 8/42（19.05%）发生 POPS，两组间差异有统计学意义（P<0.001）。影像方面，末次随访，两组腰椎前凸角、椎间隙高度、 滑脱率均较术前显著改善（P<0.05）。随时间推移，两组 Lenke 融合评级逐渐显著改善（P<0.001）；相应时间点，两组上述影像指标的差异无统计学意义（P>0.05）。［结论］保留与不保留棘突韧带复合体的减压融合术均是治疗腰椎不稳的有效方法。但保留棘突韧带复合体的术式远期疗效更好。

关键词:腰椎不稳;棘突-韧带复合体;后路椎体间融合术;术后持续综合征

Abstract:

[Objective] To compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) with or without preservation of the spinous process -ligament complex in the treatment of lumbar instability. [Methods] A retrospective study was conducted on a total of 84 pa- tients who received PLIF for lumbar instability in our hospital from February 2017 to December 2020. According to the results of preopera- tive doctor-patient communication, 42 patients had the spinous process-ligament complex preserved, while the remaining 42 patients had the spinous process-ligament complex removed routinely. The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had operation done successfully without serious complications. The preserved group proved significantly superior to the removed group in terms of intraoperative blood loss, postoperative drainage volume and VAS score of postoperative incision pain (P＜0.05) , although there was no significant difference in operation time and hospital stay between the two groups (P＞0.05) . The VAS scores of the low back pain and leg pain, ODI and JOA scores significantly improved in both groups over time (P＜0.05) . At latest follow-up, the preserved group was significantly superior to the removed group in VAS score of low back pain and JOA score (P＜0.05) , but there was no significant difference in VAS score of leg pain between the two groups (P＞0.05) . During the followup, postoperative persistent syndrome (POPS) did not occur in anyone of the preserved group, while which was of 8/42 (19.05%) in the re- moved group, with a statistically significant difference (P＜0.001) . Radiographically, the lumbar lordosis angle, intervertebral space height, and slippage percentage significantly improved in both groups at the latest follow-up compared with those before operation (P＜0.05) , addi- tionally, the Lenke fusion grade improved significantly over time in both groups (P＜0.05) . At the corresponding time points, there was no sig- nificant difference in the above imaging indexes between the two groups (P＞0.05) . [Conclusion] PLIFs with or without spinous process-lig-ament complex preservation are effective treatment of lumbar instability. By comparison, preservation of the complex is benefit to improve the long-term outcome.

Key words:lumbar instability; spinous process-ligament complex; posterior lumbar interbody fusion; postoperative persistent syn- drome