腰椎后路椎间融合术与显微内镜下保留肌肉的椎板间减压术治疗退行性腰椎滑脱症的5年以上随访比较
Comparison of Posterior Lumbar Interbody Fusion and Microendoscopic Muscle-preserving Interlaminar Decompression for Degenerative Lumbar Spondylolisthesis With >5-Year Follow-up.
作者信息
Kimura Ryota, Yoshimoto Mitsunori, Miyakoshi Naohisa, Hongo Michio, Kasukawa Yuji, Kobayashi Takashi, Kikuchi Kazuma, Okuyama Koichiro, Kido Tadato, Hirota Ryosuke, Hamada Shuto, Chiba Mitsuho, Abe Eiji, Yamashita Toshihiko, Shimada Yoichi
机构信息
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita.
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo.
出版信息
Clin Spine Surg. 2019 Oct;32(8):E380-E385. doi: 10.1097/BSD.0000000000000883.
STUDY DESIGN
Retrospective analysis of prospectively collected observational multicenter data.
OBJECTIVE
To compare the clinical results and rates of revision surgery after posterior lumbar interbody fusion (PLIF) and microendoscopic muscle-preserving interlaminar decompression (ME-MILD) in patients with single-level, mild degenerative lumbar spondylolisthesis (DLS) and follow-up of at least 5 years.
SUMMARY OF BACKGROUND DATA
Surgery for symptomatic DLS remains controversial. Evaluating long-term results may reveal problems such as adjacent segmental diseases of the PLIF and decreased quality of life because of slippage and restenosis of the ME-MILD.
METHODS
We enrolled 116 patients who underwent PLIF (79 patients) or ME-MILD (37 patients). Operative times, blood losses, surgical complications, Short-Form 36 (SF-36), Japanese Orthopedic Association (JOA) score, the JOA Back Pain Questionnaire (JOABPEQ), visual analog scales (VAS), and Zurich Claudication Questionnaire (ZCQ) were evaluated.
RESULTS
PLIF was observed to require significantly longer operative times and entailed greater operative blood losses than did ME-MILD (151.1 vs. 119.9 min; 202.2 vs. 6.4 mL, respectively). Surgery-related complications were identified in 3 cases in the PLIF group and 2 cases in the ME-MILD group. Seventy-eight patients (50 and 28 patients in the PLIF and ME-MILD groups, respectively) were successfully followed-up for >5 years. The follow-up rate was 67.2%. No significant differences between the groups were found in terms of preoperative and postoperative JOA scores, postoperative JOABPEQ, VAS, or ZCQ. Significant improvements in JOA scores were observed in both groups. Significant improvements in the SF-36 were observed in all subscales except in role physical, general health, vitality, and mental health in the ME-MILD group. Revision surgical procedures were performed in 2 patients in the ME-MILD group and 4 patients in the PLIF group.
CONCLUSIONS
PLIF and ME-MILD resulted in equivalent improvements in SF-36 and JOA scores. There were no differences in revision surgery rates among patients with single-level, mild DLS.
LEVEL OF EVIDENCE
Level III-a retrospective analysis.
研究设计
对前瞻性收集的多中心观察性数据进行回顾性分析。
目的
比较单节段轻度退行性腰椎滑脱（DLS）患者行后路腰椎椎间融合术（PLIF）和显微内镜保留肌肉的椎板间减压术（ME-MILD）后的临床结果及翻修手术率，并进行至少5年的随访。
背景数据总结
有症状的DLS手术仍存在争议。评估长期结果可能会揭示一些问题，如PLIF的相邻节段疾病以及由于ME-MILD的滑脱和再狭窄导致的生活质量下降。
方法
我们纳入了116例行PLIF（79例）或ME-MILD（37例）的患者。评估手术时间、失血量、手术并发症、简明健康状况调查量表（SF-36）、日本矫形外科学会（JOA）评分、JOA背痛问卷（JOABPEQ）、视觉模拟量表（VAS）和苏黎世跛行问卷（ZCQ）。
结果
观察到PLIF所需的手术时间明显长于ME-MILD，术中失血量也更多（分别为151.1分钟对119.9分钟；202.2毫升对6.4毫升）。PLIF组有3例发生手术相关并发症，ME-MILD组有2例。78例患者（PLIF组50例，ME-MILD组28例）成功随访超过5年。随访率为67.2%。两组在术前和术后JOA评分、术后JOABPEQ、VAS或ZCQ方面未发现显著差异。两组JOA评分均有显著改善。ME-MILD组除角色功能、总体健康、活力和心理健康外，SF-36所有子量表均有显著改善。ME-MILD组有2例患者进行了翻修手术，PLIF组有4例。
结论
PLIF和ME-MILD在SF-36和JOA评分方面带来了同等程度的改善。单节段轻度DLS患者的翻修手术率没有差异。
证据水平
III级——回顾性分析。
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