不同融合方式对多节段腰椎椎管狭窄合并腰椎间盘突出症患者应激反应的影响#br#

doi:10.13418/j.issn.1001-165x.2022.5.17

摘要/Abstract

摘要： 目的探讨多节段椎管减压配合不同融合方式对多节段腰椎椎管狭窄（LSS）合并腰椎间盘突出症（LDH）患者植骨融合情况及应激反应的影响。方法选取2017年2月～2019年2月我院多节段LSS合并LDH患者85例，按照治疗方案不同分为A组（n=43）、B组（n=42）。A组采取多节段椎管减压配合横突间植骨融合内固定术，B组采取多节段椎管减压配合椎间植骨融合术。比较两组手术有关指标情况、术前、术后1 d、3 d血清应激反应有关指标［血管紧张素Ⅱ（AngⅡ）、肾素（R）、超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）］水平、并发症、疗效、植骨融合情况、术前、术后1周、12个月、24个月腰腿痛视觉模拟评分量表（VAS）评分、日本骨科学会（JOA）评分、功能障碍指数量表（ODI）评分。结果 A组手术时间、住院时间短于B组，术中出血量与住院费用低于B组（P<0.05）；两组术后1 d、3 d血清AngⅡ、R、hs-CRP、IL-6水平均较本组术前提高（P<0.05），A组术后1 d、3 d上述血清指标水平均低于B组（P<0.05）；两组并发症发生率相比，差异无统计学意义（P>0.05）；两组手术优良率、植骨融合率相比，差异无统计学意义（P>0.05）；两组术后1周、术后3个月、12个月、24个月腰腿痛VAS评分、ODI评分均较本组术前降低，JOA评分较本组术前提高（P<0.05），但组间对比，差异无统计学意义（P>0.05）。结论多节段椎管减压配合横突间植骨融合内固定术或椎间植骨融合术均是治疗多节段LSS合并LDH值得肯定的术式，临床疗效满意，而横突间植骨融合内固定术具有创伤小、出血少、恢复快、住院费用低的优势。

关键词: 多节段椎管减压, , , 横突间植骨融合内固定术, , , 椎间植骨融合术, , , 多节段, , , 腰椎椎管狭窄, , , 腰椎间盘突出症, , , 植骨融合, , , 应激反应

Abstract: Objective To investigate the effect of multi-segmental spinal decompression combined with different fusion methods on bone graft fusion and stress response in patients with multi-segment lumbar spinal stenosis (LSS) combined with lumbar disc herniation (LDH). Methods A total of 85 patients with multi-segment LSS and LDH in our hospital from February 2017 to February 2019 were selected and divided into group A (n=43) and group B (n=42) according to different treatment plans. Group A was treated with multi-segment spinal canal decompression combined with internal fixation with bone grafting and fusion between transverse processes, and group B was treated with multi-segment spinal canal decompression combined with intervertebral bone grafting and fusion. The conditions of related indexes of operation and related indexes of serum stress response [angiotensin II (Ang II), renin (R), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6)] levels before operation, 1 d and 3 d after operation, complications, curative effects, and bone graft fusion were compared between the two groups, as well as the visual analogue scale (VAS) score, the Japanese Orthopaedic Association (JOA) score, and the dysfunction index (ODI) scores before operation, 1 week, 12 months and 24 months after operation. Results The operation time and hospitalization time of group A were shorter than those of group B, and the blood loss and hospitalization expenses during operation were lower than those of group B (P<0.05). The levels of serum AngⅡ, R, hs-CRP, and IL-6 at 1 and 3 days after operation in the two groups were higher than those in the group before operation (P<0.05). The above-mentioned serum index levels in group A were lower than those in group B on the 1st and 3rd day after operation (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). There was no statistically significant difference in the excellent and good rate of surgery and the rate of bone graft fusion between the two groups (P>0.05). The VAS scores and ODI scores of low back pain at 3 months, 12 months, and 24 months after operation in the two groups were lower than those of this group before surgery, and the JOA score was higher than that of this group before operation (P<0.05), but the difference between the groups was not statistically significant (P>0.05). Conclusions Multi-segment spinal canal decompression combined with intertransverse process bone grafting and internal fixation or intervertebral bone grafting and fusion are both affirmative surgical procedures for the treatment of multi-level LSS combined with LDH, and the clinical effect is satisfactory. The intertransverse process bone graft fusion and internal fixation has the advantages of less trauma, less bleeding, faster recovery, and low hospitalization costs.

Key words: Multi-segment spinal canal decompression, , , Intertransverse process bone graft fusion and internal fixation, , , Intervertebral bone graft fusion, , , Multi-segment, , , Lumbar spinal stenosis, , , Lumbar disc herniation, Bone graft fusion, Stress response

中图分类号:

R681.5

李锐, 张仁赞, 刘正蓬, 孙贺, 张义龙. 不同融合方式对多节段腰椎椎管狭窄合并腰椎间盘突出症患者应激反应的影响#br#[J]. 中国临床解剖学杂志, 2022, 40(5): 599-604.

Li Rui, Zhang Renzan, Liu Zhengpeng, Sun He, Zhang Yilong. Effect of different fusion methods on stress response in patients with multi segmental lumbar spinal stenosis combined with lumbar disc herniation[J]. Chinese Journal of Clinical Anatomy, 2022, 40(5): 599-604.

参考文献 15

[1]	Yuan T, Zhang J, Yang L, et al. Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery:A case report[J].Medicine(Baltimore),2019,98(29):e16396. DOI:10.1097/MD.0000000000016396.
[2]	宋永兴,曾忠友,宋国浩,等.通道下经肌间隙入路联合固定并椎间融合术治疗老年人腰椎退行性疾病的近期疗效[J].中华老年医学杂志,2018,37(11):1266-1271.DOI:10.3760/cma.j.issn.0254-9026.2018. 11.020.
[3]	Austevoll IM,Gjestad R,Brox JI,et al. The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery[J].Eur Spine J,2016,26(2):404-413. DOI:10.1007/s00586-016-4683-1.
[4]	廖烨晖,叶入裴,唐强,等.超声骨刀单侧开窗双侧减压后路腰椎椎体间融合术治疗退变性腰椎管狭窄症[J].中国修复重建外科杂志, 2019, 33(4): 416-422. DOI:10.7507/1002-1892.201808037.
[5]	成伟益, 曾茜茜, 肖宝钧, 等.导航电子显微镜下腰椎后路椎管减压植骨融合术治疗老年退行性椎管狭窄症疗效观察[J].中国骨与关节损伤杂志,2020,35(3):286-287.DOI:10.7531/j.issn.1672-9935. 2020. 03.022.
[6]	余将明, 马俊, 谢宁, 等. 斜外侧腰椎椎间融合术间接减压治疗退行性腰椎管狭窄症的早期疗效[J].中华骨科杂志, 2017, 37(16): 972-979. DOI:10.3760/cma.j.issn.0253-2352.2017.16.003.
[7]	Sun F, Liang Q, Yan M, et al. Unilateral Laminectomy by Endoscopy in Central Lumbar Canal Spinal Stenosis: Technical Note and Early Outcomes[J].Spine,2020,45(14):E871-E877. DOI:10.1097/BRS.0000000000003478
[8]	姜树东, 任龙喜, 郭函, 等. 单侧减压机器人辅助微创经椎间孔腰椎间融合治疗影像学双侧腰椎管狭窄[J].中国组织工程研究, 2020, 24(24):3797-3802,3845. DOI:10.3969/j.issn.2095-4344.2720.
[9]	Tecle N, Dahdaleh NS. Fusion Surgery for Lumbar Spinal Stenosis[J]. N Eng J Med, 2016, 375(6): 597. DOI:10.1056/NEJMc1606502
[10]	贾栋, 夏群, 杨凯锐, 等.单纯减压与减压融合术治疗老年退行性腰椎管狭窄症中远期疗效的Meta分析[J]. 中国骨与关节损伤杂志,2020, 35(1):22-25. DOI:10.7531/j.issn.1672-9935.2020.01.006.
[11]	高飞, 王高强, 阿日奔吉日嘎拉, 等.双侧椎小关节间植骨融合与椎间融合器置入融合在退行性腰椎不稳治疗中的临床效果比较[J].中国骨与关节杂志, 2017, 6(3):216-219. DOI:10.3969/j.issn.2095-252X. 2017.03.011.
[12]	Ulrich NH, Burgstaller JM, Pichierri G, et al. Decompression Surgery Alone Versus Decompression Plus Fusion in Symptomatic Lumbar Spinal Stenosis:A Swiss Prospective Multi-center Cohort Study with 3 Years of Follow-up[J].Spine,2017,42(18):E1077-E1086. DOI:10.1097/BRS.0000000000002068.
[13]	刘广泉, 李海亮, 马晓春, 等. 斜外侧腰椎间融合术治疗腰椎滑脱的早期临床结果及远期生活质量评价[J].中国临床医生杂志, 2020, 48(3):322-324. DOI:10.3969/j.issn.2095-8552.2020.03.022.
[14]	刘纪涛, 潘勇. 经皮椎间孔镜手术及开放椎板间开窗手术后的疼痛程度、炎症应激程度比较[J].海南医学院学报, 2018, 24(2):198-201. DOI:10.13210/j.cnki.jhmu.20180102.005.
[15]	王齐超, 张生, 张永辉, 等. 经皮椎间孔镜TESSYS技术对腰椎间盘突出症患者应激反应及治疗效果的影响[J]. 颈腰痛杂志, 2018, 39(6):754-757. DOI:10.3969/j.issn.1005-7234.2018.06.004.