后路椎间融合术与后前路联合手术治疗老年骨质疏松性椎体骨折合并腰椎管狭窄症的临床疗效比较

doi:10.3969/j.issn.1671-7171.2020.09.011

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摘要 【目的】 比较后路椎间融合术(posterior intervertebral fusion,PLIF)与后前路联合手术(anterior and posterior combined surgery,PACS)治疗老年骨质疏松性椎体骨折(osteoporotic vertebral fracture,OVCF)合并腰椎管狭窄症(lumbar spinal stenosis,LSS)的临床疗效。【方法】 回顾性分析2013年1月至2018年1月在本院诊治的OVCF合并LSS的37例老年患者临床资料,其中14例接受PLIF治疗(PLIF组),23例接受PACS治疗(PACS组)。比较两组患者手术时间、失血量、术后住院时间、术后并发症等临床资料,观察两组患者手术前后美国脊柱损伤协会损伤量表(AIS)评级、腰椎前凸角(LLA)和骨融合结果。【结果】 PLIF组和PACS组患者术后AIS分级与术前比较均显著改善(P<0.05),但两组术前和术后AIS分级比较差异均无统计学意义(P>0.05)。PLIF组和PACS组患者术后日常生活活动能力量表(ADLs)分级与术前比较均显著改善(P<0.05),术前、术后两组ADLs比较差异均无统计学意义(P>0.05)。PLIF组手术时间、术中失血量、术后住院时间均显著少于PACS组(P<0.05)。PLIF组和PACS组患者术前、术后、末次随访LLA和LLA矫正度、矫正损失、脊柱融合率比较差异均无统计学意义(P>0.05)。PLIF和PACS组肺部感染、硬脑膜撕裂、刀口感染、椎弓根螺钉松动、相邻椎体骨折、再手术等发生率比较差异均无统计学意义(P>0.05)。【结论】 对于OVCF 合并LSS 老年患者,PLIF可通过单一后入路进行充分椎管减压,通过椎弓根螺钉和钩钉系统实现后固定,其手术创伤低于PACS,临床疗效满意,值得临床推广应用。

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	柯昌武

关键词 ：骨折/外科学, 骨质疏松/并发症, 椎管狭窄/外科学, 脊柱融合术

Abstract：【Objective】 To investigate the efficacy and safety of posterior lumbar interbody fusion (PLIF) and posterior-anterior combined surgery (PACS) in the treatment of osteoporotic vertebral compression fracture (OVCF) with lumbar spinal stenosis (LSS).【Methods】 The clinical data of 37 elderly patients with OVCF complicated with LSS who were treated in our hospital from January 2013 to January 2018 were retrospectively analyzed. Among them, 14 cases were treated with PLIF (PLIF group), and 23 cases were treated with PACS (PACS group). The operation time, blood loss, postoperative hospital stay, postoperative complications and other clinical data were compared between the two groups. The American Spinal Injury Association Injury Scale (AIS) rating, lumbar lordosis angle (LLA) and bone fusion results of the two groups were observed before and after operation.【Results】 The AIS grading of the PLIF group and the PACS group was significantly improved compared with that before operation (P<0.05), but there was no significant difference in AIS grading between the two groups before and after operation (P>0.05). The ADLs scores of the PLIF group and the PACS group were significantly improved compared with those before operation (P<0.05). There was no significant difference in ADLs between the two groups before and after operation (P>0.05). The operation time, intraoperative blood loss and postoperative hospital stay in the PLIF group were significantly less than those in the PACS group (P<0.05).There was no significant difference between the PLIF group and the PACS group in LLA, LLA correction degree, correction loss and spinal fusion rate before, after and at the last follow-up (P>0.05). There was no significant difference in the incidence of pulmonary infection, dural tear, knife edge infection, pedicle screw loosening, adjacent vertebral fracture and reoperation between the PLIF group and the PACS group (P>0.05).【Conclusion】 For the elderly patients of OVCF combined with LSS, PLIF can fully decompress the spinal canal through a single posterior approach, and achieve posterior fixation through pedicle screw and hook screw system. Its surgical trauma is lower than that of PACS, and the clinical effect is satisfactory, which is worthy of clinical application.

Key words： Fractures Bone/SU Osteoporosis/CO Spinal Stenosis/SU Spinal Fusion

收稿日期: 2020-07-28

PACS:

R683

引用本文:

柯昌武. 后路椎间融合术与后前路联合手术治疗老年骨质疏松性椎体骨折合并腰椎管狭窄症的临床疗效比较[J]. 医学临床研究, 2020, 37(9): 1312-1315.
KE Chang-wu. Comparison of the Clinical Efficacy of PLIF with PACS in the treatment of OVCF with LSS. JOURNAL OF CLINICAL RESEARCH, 2020, 37(9): 1312-1315.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2020.09.011 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2020/V37/I9/1312

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