Posterior lumbar interbody fusion plus screw implantation with posterior ligamentous complexes under microscope for lumbar degenerative disease

doi:10.3969/j.issn.2095-4344.2017.23.013

Abstract

Abstract:

BACKGROUND: Removing the posterior ligamentous complexes during posterior lumbar interbody fusion (PLIF) may influence motion and load bearing characteristics of the adjacent segments, contributing to the postoperative instability at the adjacent segment, which is one of the important factors for adjacent segment degeneration.

OBJECTIVE: To evaluate the clinical effectiveness of the PLIF plus screw implantation preserving posterior ligamentous complexes under microscope．

METHODS: Thirty-six patients with single-level lumbar degenerative disease were enrolled, which were allotted to experimental (n=17) and control (n=19) groups, followed by treated with PLIF plus screw implantation preserving posterior ligamentous complexes, and traditional PLIF plus screw implnatation, respectively. The Visual Analogue Scale scores and Oswestry Dysfunction Index at baseline and postoperative 3 months were assessed. The adjacent segment degeneration was observed through radiology during follow-up.

RESULTS AND CONCLUSION: The Visual Analogue Scale and Oswestry Dysfunction Index scores in the two groups were significantly lower than those before treatment (P < 0.01), and the postoperative scores in the experimental group were significantly lower than those in the control group (P < 0.01). The adjacent segment degeneration occurred in two cases in the experimental group and 8 cases in the control group during follow-up. Radiology revealed that the internal fixative was stable, none of screw loosening, rupture or pullout. These results suggest that PLIF plus screw implantation with posterior ligamentous complexes can effectively relieve the pain and dysfunction in the lumbar degenerative patients, and reduce the incidence of adjacent segment degeneration.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Surgical Procedures, Minimally Invasive, Spinal Fusion, Tissue Engineering

CLC Number:

R318

Ji Jing-tao, Miao Jun, Li Wen-jun, Zhu Shan. Posterior lumbar interbody fusion plus screw implantation with posterior ligamentous complexes under microscope for lumbar degenerative disease [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(23): 3682-3687.

Figures/Tables 1

2.1 参与者数量分析 36例患者均完成治疗后3-26个月的门诊随访，进入结果分析。 2.2 试验分组流程图见图2。 2.3 两组基线资料比较两组患者性别比例、年龄、病变部位、疾病类型等基线资料比较差异无显著性意义，具有可比性。 2.4 手术情况试验组手术时间70-140 min，平均 130 min；术中出血量100-800 mL，平均260 mL。对照组手术时间90-150 min，平均145 min；术中出血量400- 1 200 mL，平均640 mL。 2.5 疼痛缓解 36例患者术后24 h后腰腿痛症状均有不同程度缓解，8例患者术后拔出引流管后出现单侧下肢疼痛、麻木症状，经过神经营养、脱水药物及小剂量激素治疗后症状缓解。试验组3例患者随访期间偶有腰部不适症状，通过休息或口服非类固醇抗炎药物均可缓解，17例患者随访期间腰腿痛症状无复发。对照组11例患者随访期间平卧时出现腰部不适症状，6例患者腰痛明显，需借助腰围或口服非类固醇抗炎药物缓解。 2.6 目测类比评分与Oswestry功能障碍指数评分的比较治疗前，两组间目测类比评分、Oswestry 功能障碍指数评分比较差异均无显著性意义；两组治疗后3个月的目测类比评分、Oswestry 功能障碍指数评分均明显低于治疗前(P < 0.01)，试验组治疗后3个月的目测类比评分、Oswestry 功能障碍指数评分明显低于对照组(P < 0.01)，见表1。 2.7 影像学检查结果试验组2例出现手术节段头侧椎间隙高度丢失> 3 mm，但未发生椎体位移。对照组 8例出现手术节段头侧椎间隙高度丢失> 3 mm，2例出现手术节段头侧椎体前滑移>3 mm，同时存在动力位下椎间隙角度变化> 5°。 2.8 置钉后腰椎稳定性术后36例患者随访期间X射线片显示内固定稳定，无椎间cage松动、退出，无椎弓根钉松动、断裂或脱出等并发症发生。 2.9 植入材料不良反应此次研究中两组均未发生与植入材料相关的不良反应。 2.10 典型病例影像学图片见图3。"

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