改良椎板截骨回植与传统椎板截骨回植治疗腰椎间盘突出症合并腰椎不稳的疗效比较
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作者Author单位AddressE-Mail
段大鹏 DUAN Da-peng 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
卫文博 WEI Wen-bo 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
孙正明 SUN Zheng-ming 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
徐洪海 XU Hong-hai 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China honghaixu@yeah.net 
刘宗智 LIU Zong-zhi 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
弓立群 GONG Li-qun 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
常彦海 CHANG Yan-hai 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
李全义 LI Quan-yi 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
马战胜 MA Zhan-sheng 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
刘时璋 LIU Shi-zhang 陕西省人民医院骨科病院, 陕西 西安 710068 Orthopedic Hospital of Shaanxi People's Hospital, Xi'an 710068, Shaanxi, China  
期刊信息:《中国骨伤》2018年,第31卷,第8期,第757-762页
DOI:10.3969/j.issn.1003-0034.2018.08.014
基金项目:陕西省科技统筹创新工程计划项目(编号2015KTCL03-02)
中文摘要:

目的:评价改良椎板截骨回植与传统椎板截骨回植治疗腰椎间盘突出症合并腰椎不稳的临床疗效。

方法:对2008年3月至2013年3月手术治疗的146例单侧腰椎间盘突出症合并腰椎失稳患者的临床资料进行分析,其中传统椎板截骨回植组(传统组)77例,男42例,女35例,年龄(49.4±18.5)岁,突出节段L4,5 46例,L5S1 31例;改良椎板截骨回植组(改良组)69例,男37例,女32例,年龄(49.8±17.9)岁;突出节段L4,5 40例,L5S1 29例。对两组患者的手术时间、术中出血量、术中神经及硬膜囊损伤率、术后椎板愈合率及腰腿痛复发率进行比较;并采用视觉模拟量表(VAS)评分及日本骨科协会(JOA)评分评价两组患者的临床疗效。

结果:两组患者在手术时间、术中出血量上的差异无统计学意义。改良组神经损伤率和硬膜囊损伤率分别为5.80%(4/69)和1.45%(1/69),传统组分别为16.9%(13/77)和9.09%(7/77),两组比较差异有统计学意义(P<0.05);3年椎间融合率和腰痛复发率改良组分别为91.3%(63/69)、8.70%(6/69),传统组分别为76.62%(59/77)、29.9%(23/77),两组比较差异有统计学意义。术后6个月,1、2、3年VAS评分较术前降低,而JOA评分均较术前升高(P<0.05)。术后1、2、3年改良组VAS评分均小于传统组(P<0.05),而JOA评分均大于传统组(P<0.05)。

结论:改良椎板截骨回植在改善腰椎间盘突出症合并腰椎不稳的长期疗效(3年腰痛复发率、椎间融合率、VAS评分及JOA评分)方面优于目前传统椎板截骨回植术。
【关键词】腰椎  椎间盘移位  腰椎不稳  椎板  回植  病例对照研究
 
Efficacy evaluation of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in treating lumbar disc herniation with lumbar instability
ABSTRACT  

Objective:To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability.

Methods:The clinical data of 146 patients with unilateral lumbar disc herniation with lumbar instability underwent surgical treatment from March 2008 to March 2013 were retrospectively analyzed. Patients were divided into two groups according to osteotomy replantation pattern. There were 77 patients in the traditional group (underwent traditional lamina osteotomy replantation),including 42 males and 35 females with an average age of (49.4±18.5) years;the lesions occurred on L4,5 in 46 cases,on L5S1 in 31 cases. There were 69 patients in modified group (underwent modified lamina osteotomy replantation),including 37 males and 32 females with an average age of (49.8±17.9) years;the lesions occurred on L4,5 in 40 cases,on L5S1 in 29 cases. The operation time,intraoperative blood loss,complication rate during operation,lamina healing rate,recurrence rate of low back and leg pain were compared between two groups. Visual analogue scales (VAS) and Japanese Orthopadic Association (JOA) scores were used to evaluate the clinical effects.

Results:The operation time and intraoperative blood loss were similar between two group (P>0.05). There was significantly different in nerve injury rate(5.80% vs 16.9%) and dural injury rate(1.45% vs 9.09%) between modified group and traditional group(P<0.05). The recurrent rate of low back pain of modified group was higher (91.30%,63/69) than that of traditional group (76.62%,59/77),and the intervertebral fusion rate of modified group was lower(8.70%,6/69) than that of traditional group (29.9%,23/77) at 3 years after operation. Postoperative VAS scores of all patients were significantly decreased at 6 months,1,2,3 years,and JOA scores were obviously increased (P<0.05). At 1,2,3 years after operation,VAS scores of modified group were significantly lower than that of traditional group(P<0.05),and JOA scores of modified group were higher than that of traditional group(P<0.05).

Conclusion:Modified lamina osteotomy replantation has better long-term efficacy(in the aspect of recurrent rate of low back pain,intervertebral fusion rate,VAS and JOA score at three years follow-up) in treating lumbar disc herniation with instability.
KEY WORDS  Lumbar vertebrae  Intervertebral disk displacement  Lumbar instability  Lamina  Replantation  Case-control study
 
引用本文,请按以下格式著录参考文献:
中文格式:段大鹏,卫文博,孙正明,徐洪海,刘宗智,弓立群,常彦海,李全义,马战胜,刘时璋.改良椎板截骨回植与传统椎板截骨回植治疗腰椎间盘突出症合并腰椎不稳的疗效比较[J].中国骨伤,2018,31(8):757~762
英文格式:DUAN Da-peng,WEI Wen-bo,SUN Zheng-ming,XU Hong-hai,LIU Zong-zhi,GONG Li-qun,CHANG Yan-hai,LI Quan-yi,MA Zhan-sheng,LIU Shi-zhang.Efficacy evaluation of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in treating lumbar disc herniation with lumbar instability[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(8):757~762
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