| 王兆宁,郑立峰,陈 岩,王 宝,王 可.L4-5单节段TLIF单侧或者双侧小关节突切除术后临床疗效及影像学参数的分析[J].,2017,17(36):7076-7080 |
| L4-5单节段TLIF单侧或者双侧小关节突切除术后临床疗效及影像学参数的分析 |
| Analysis of Clinical Efficacy and Changes of Radiographic Parameters in Patients Receiving L4-5 Single-segment TLIF with Unilateral or Bilateral Facetectomy |
| 投稿时间：2017-06-24 修订日期：2017-07-18 |
| DOI：10.13241/j.cnki.pmb.2017.36.017 |
| 中文关键词: 单节段TLIF 临床疗效 影像学参数 差异 |
| 英文关键词: Single-segment TLIF Clinical efficacy Radiographic parameters Difference |
| 基金项目:国家自然科学基金项目（81572252） |
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| 中文摘要: |
| 摘要 目的：分析L4-5单节段TLIF单侧或者双侧小关节突切除术后患者临床疗效和影像学参数的改变。方法：收集2009年1月份到2012年12月份于我院行L4-5单节段TLIF融合手术且随访时间大于24个月的患者。根据小关节切除的情况分为单侧切除组（单侧组）和双侧切除组（双侧组），分别有42例和34例患者。两组患者分别在术前和随访时测量如下影像学参数：骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰椎前凸角（LL）和节段前凸角（SL），比较术前和随访时的变化。通过术前和随访时视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评估两组患者临床疗效。结果：患者平均随访时间为36.5±13.5个月。两组患者手术时间没有统计学差异（P=0.110），双侧组术中出血量（311±89.3 mL）大于单侧组（263±69.7 mL）（P<0.05），术中并发症没有统计学差异（P=0.685）。两组患者随访时LL和SL均大于术前，PT小于术前，差异具有统计学意义（P<0.05）。PI均没有明显变化。双侧组术后PT小于单侧组（P<0.001）。两组患者随访时△LL、△SL、△PI和△SS均没有差异（P>0.05），但是双侧组△PT大于单侧组（P<0.001）。两组患者随访时VAS和ODI均较术前明显减小（P<0.05）。双侧组随访时VAS和ODI均小于单侧组（P<0.05）。结论：双侧小关节切除并不能比单侧切除提高更多LL和SL，但是比单侧小关节切除临床疗效好。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the clinical efficacy and changes of imaging parameters in patients receiving L4-5 single-segment TLIF with unilateral or bilateral facetectomy. Methods: Patients who received L4-5 single-segment TLIF in our hospital from January 2009 to December 2012 and were followed up for more than 24 months were enrolled in the study. They was divided into unilateral facetectomy group (unilateral group) and bilateral facetectomy group (bilateral group) according to the situation of facet joint resection, respectively, 42 and 34 cases. The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and segmental segmentallordosis (SL) were measured in two groups before surgery and at last follow-up. Besides, the differences of radiographic parameters before surgery and at last follow-up were evaluated. The clinical efficacy of both groups was assessed by preoperative and follow-up Visual Analogue Scale (VAS) and the Oswestry Dysfunction Index (ODI). Results: The mean follow-up time was 36.5 ± 13.5 months. There was no significant difference in the operation time between the two groups (P = 0.110). The intraoperative blood loss (311 ± 89.3 mL) in the bilateral group was significantly higher than that in the unilateral group (263 ± 69.7 mL) (P <0.05) (P = 0.685). LL and SL of both groups were higher at follow-up than those before operation, PT at follow-up was less than that before surgery, and the differences were statistically significant (P <0.05). PI did not change significantly. The postoperative PT was smaller in the bilateral group than in the unilateral group (P <0.001). There was no difference in △LL, △SL, △PI and △SS between the two groups (P> 0.05), but the △PT in the bilateral group was higher than that in the unilateral group (P <0.001). VAS and ODI significantly decreased in both groups at follow-up (P <0.05). VAS and ODI were smaller in the bilateral group than in the unilateral group (P <0.05). Conclusion: Bilateral facetectomy does not improve more LL and SL than unilateral facetectomy, however, has better clinical efficacy. |
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