| 伴或不伴马尾冗余征腰椎管狭窄症患者行斜外侧腰椎椎间融合术联合后路经皮内固定术的疗效分析 |
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Received:December 07, 2023
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| 作者 | Author | 单位 | Unit | E-Mail |
| 孙竑洲 |
SUN Hong-zhou |
皖南医学院弋矶山医院脊柱骨科, 安徽 芜湖 241001 |
Department of Spine Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China |
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| 张玙 |
ZHANG Yu |
皖南医学院弋矶山医院脊柱骨科, 安徽 芜湖 241001 |
Department of Spine Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China |
lakerszy@126.com |
| 肖良 |
XIAO Liang |
皖南医学院弋矶山医院脊柱骨科, 安徽 芜湖 241001 |
Department of Spine Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China |
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| 赵泉来 |
ZHAO Quan-lai |
皖南医学院弋矶山医院脊柱骨科, 安徽 芜湖 241001 |
Department of Spine Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China |
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| 刘晨 |
LIU Chen |
皖南医学院弋矶山医院脊柱骨科, 安徽 芜湖 241001 |
Department of Spine Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China |
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| 吴仲宣 |
WU Zhong-xuan |
皖南医学院弋矶山医院脊柱骨科, 安徽 芜湖 241001 |
Department of Spine Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China |
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| 期刊信息：《中国骨伤》2024年37卷，第4期，第345-351页 |
| DOI：10.12200/j.issn.1003-0034.20230377 |
| 基金项目:国家自然科学基金青年项目(编号:82002358);安徽省医疗创新基金项目(编号:AHJZJX-GG2022-002) |
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目的: 探讨伴或不伴马尾冗余征(redundant nerve roots,RNRs)腰椎管狭窄症患者行斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)联合后路经皮内固定术的临床疗效。
方法: 回顾性分析2019年6月至2022年6月于本院采用斜外侧腰椎椎间融合术联合后路经皮内固定术治疗的92例腰椎管狭窄症患者,男32例,女60例,年龄44~82(63.67±9.93)岁。根据冗余与否将所有患者分为RNRs阳性组和 RNRs阴性组。RNRs阳性组38例,男15例,女23例;年龄 45~82(65.45±10.37)岁;病程24.00(12.00,72.00)个月。RNRs阴性组54例,男17例,女37例;年龄44~77(62.42±9.51)岁;病程13.50(9.00,36.00)个月。记录两组手术时间、术中出血量、并发症;手术前后影像学参数,包括狭窄节段数、椎间隙高度、腰椎前凸角、硬膜囊面积;采用视觉模拟评分(visual analogue scale,VAS)进行背部和腿部疼痛评价,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估日常生活活动障碍。
结果: 所有患者获得随访,时间8~18(11.04±3.61)个月,随访期未见并发症。RNRs阳性组狭窄节段数(1.71±0.46)个,多于阴性组(1.17±0.38)个(P<0.05)。RNRs阳性组术前椎间隙高度、硬膜囊面积、腰痛VAS、腿痛VAS、ODI分别为(1.11±0.19) cm、(0.46±0.17) cm2、(5.39±1.00)分、(5.05±1.01)分、(55.74±4.05) %;RNRs阴性组分别为(0.97±0.23) cm、(0.69±0.26) cm2、(4.50±0.77)分、(4.00±0.58)分、(47.33±3.43) %。RNRs阳性组术后椎间隙高度、硬膜囊面积、腰痛VAS、腿痛VAS、ODI评分分别为(1.60±0.19) cm、(0.74±0.36) cm2、(3.39±0.72)分、(3.05±1.01)分、(46.74±4.82) %;RNRs阴性组分别为(1.48±0.25) cm、(1.12±0.35) cm2、(3.00±0.82)分、(3.00±0.82)分、(37.67±3.58) %。两组术后椎间隙高度、硬膜囊面积、腰痛、腿痛VAS、ODI较术前明显改善(P<0.05)。两组术前椎间隙高度、硬膜囊面积、腰痛、腿痛VAS、ODI比较,差异均具有统计学意义(P<0.05)。但两组手术前后椎间隙高度差值、ODI差值比较,差异无统计学意义(P>0.05)。两组手术时间、术中出血量、术后硬膜囊面积、手术前后硬膜囊面积差值、术后腰痛VAS、手术前后腰痛VAS差值、手术前后腿痛VAS差值等比较,差异有统计学意义(P<0.05)。
结论: OLIF联合后路经皮内固定术对于伴或不伴RNRs的患者均有较好疗效。多节段腰椎管狭窄、硬膜囊面积减小可能会导致RNRs的发生,伴RNRs的LSS患者症状更重。伴RNRs的LSS患者较不伴RNRs的患者手术疗效要差。 |
| [关键词]:马尾冗余征 腰椎管狭窄症 斜外侧腰椎椎间融合术 后路经皮内固定术 |
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| Efficacy analysis of OLIF combined with posterior percutaneous internal fixation in patients with lumbar spinal stenosis with or without redundant nerve roots |
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Abstract:
Objective To investigate the clinical efficacy of oblique lumbar interbody fusion(OLIF) combined with posterior percutaneous internal fixation in patients with lumbar spinal stenosis with or without redundant nerve roots(RNRs).
Methods A retrospective analysis of 92 patients with lumbar spinal stenosis treated by oblique lateral lumbar interbody fusion combined with posterior percutaneous internal fixation from June 2019 to June 2022 was performed. There were 32 males and 60 females,aged from 44 to 82 years old with an average of (63.67±9.93) years old. All patients were divided into RNRs positive group and RNRs negative group according to redundancy or not before operation. There were 38 patients in RNRs positive group,including 15 males and 23 females. The age ranged from 45 to 82 years old with an average of (65.45±10.37) years old. The disease duration was 24.00(12.00,72.00) months. There were 54 patients in RNRs negative group,including 17 males and 37 females. The age ranged from 44 to 77 years old with an average of (62.42±9.51) years old. The disease duration was 13.50(9.00,36.00) months. The general data of patients were recorded,including operation time,intraoperative blood loss and complications. The imaging parameters before and after operation were observed,including the number of stenosis segments,intervertebral space height,lumbar lordosis angle and dural sac area. The visual analogue scale (VAS) was used to evaluate the back and lower extremity pain,and the Oswestry disability index (ODI) was used to evaluate the activities of daily living.
Results All patients were followed up for 8 to 18 months with an average of (11.04±3.61) months,and no complications were found during the follow-up period.The number of stenosis segments in RNRs positive group (1.71±0.46) was more than that in RNRs negative group(1.17±0.38). In RNRs positive group,intervertebral space height,dural sac area,low back pain VAS,lower extremity pain VAS,ODI score were (1.11±0.19) cm,(0.46±0.17) cm2,(5.39±1.00) scores,(5.05±1.01) points,(55.74±4.05) points,respectively. RNRs negative groups respectively (0.97±0.23) cm,(0.69±0.26) cm2,(4.50±0.77) scores,(4.00±0.58) scores,(47.33±3.43) %. In RNRs positive group,intervertebral space height,dural sac area,low back pain VAS,leg pain VAS,ODI score were (1.60±0.19) cm,(0.74±0.36) cm2,(3.39±0.72) scores,(3.05±1.01) scores,(46.74±4.82) scores,respectively. RNRs negative groups respectively (1.48±0.25) cm,(1.12±0.35) cm2,(3.00±0.82) scores,(3.00±0.82) scores,(37.67±3.58) %. The postoperative intervertebral space height,dural sac area,low back pain VAS score,lower extremity pain VAS and ODI score of the patients in the RNRs positive group and the negative group were significantly improved compared with those before operation,and the differences were statistically significant (P<0.05). There were statistically significant differences in the number of stenosed segments,preoperative intervertebral space height,dural sac area,low back pain VAS,lower extremity pain VAS,and ODI between the two groups(P<0.05). There were significant differences in postoperative intervertebral space height and postoperative ODI between the two groups(P<0.05),but there was no significant difference in intervertebral space height before and after operation and ODI score before and after operation(P>0.05). There were significant differences in operation time,intraoperative blood loss,postoperative dural sac area,difference of dural sac area before and after operation,postoperative low back pain VAS,difference of low back pain VAS score before and after operation,difference of lower extremity pain VAS before and after operation between the two groups(P<0.05).
Conclusion OLIF combined with posterior percutaneous internal fixation has a good effect on patients with or without RNRs. Multi-segmental lumbar spinal stenosis and decreased dural sac area may lead to the occurrence of RNRs,and LSS patients with RNRs have more severe symptoms. LSS patients with RNRs have worse surgical outcomes than those without RNRs. |
| KEYWORDS:Redundant nerve roots Lumbar spinal stenosis Oblique lateral lumbar interbody fusion Posterior percutaneous internal fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙竑洲,张玙,肖良,赵泉来,刘晨,吴仲宣.伴或不伴马尾冗余征腰椎管狭窄症患者行斜外侧腰椎椎间融合术联合后路经皮内固定术的疗效分析[J].中国骨伤,2024,37(4):345~351 |
| 英文格式: | SUN Hong-zhou,ZHANG Yu,XIAO Liang,ZHAO Quan-lai,LIU Chen,WU Zhong-xuan.Efficacy analysis of OLIF combined with posterior percutaneous internal fixation in patients with lumbar spinal stenosis with or without redundant nerve roots[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(4):345~351 |
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