改良关节突关节融合与后外侧融合治疗腰椎退变性疾病的比较：一项回顾性研究。
Comparison between modified facet joint fusion and posterolateral fusion for the treatment of lumbar degenerative diseases: a retrospective study.
机构信息
Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Hutong, Dong Cheng District, Beijing, 100730, China.
出版信息
BMC Surg. 2022 Jan 28;22(1):29. doi: 10.1186/s12893-022-01468-4.
OBJECTIVE
To investigate the safety and effectiveness of modified facet joint fusion in the treatment of lumbar degenerative diseases and compare them with those of posterolateral fusion.
METHODS
A total of 77 adult patients with lumbar degenerative disease diagnosed from January 2017 to February 2019 were considered for the present retrospective, nonrandomized, and controlled study. The patients were divided into two groups according to the fusion technique used during the surgery: the posterolateral fusion (PLF) group (n = 42) and the modified facet joint fusion (MFF) group (n = 35). The fusion rate, Oswestry Disability Index (ODI) score, visual analog scale (VAS) score for back pain and leg pain, Japanese Orthopedic Association (JOA) score, European Quality of Life-5 Dimensions (EQ-5D) score, length of hospital stay, length of operation, intraoperative blood loss, cost of hospitalization, complications and reoperations were compared between the 2 groups.
RESULTS
All patients underwent a successful surgery, and all were followed up. No significant differences were found in age, sex, BMI, length of hospital stay, length of operation or cost of hospitalization. There were no significant differences in the preoperative or postoperative ODI or in the VAS, JOA, and EQ-5D scores between the MFF and PLF groups. However, the fusion rate of MFF group was higher than that of the PLF group (P < 0.05). What's more, the MFF group had less intraoperative blood loss than the PLF group (P < 0.05). Complications related to iatrogenic nerve injury, vascular injury, epidural hematoma, intravertebral infection, and internal fixation did not occur in either group. None of the patients required reoperation.
CONCLUSIONS
Modified facet joint fusion is safe and efficient in the treatment of lumbar degenerative disease. The fusion rate of MFF was higher than PLF. The intraoperative blood loss of MFF was less than that of PLF. In addition, the therapeutic effect of MFF was not worse than that of PLF. Therefore, the MFF technique can be promoted in clinical treatment.
目的
探讨改良关节突关节融合术治疗腰椎退行性疾病的安全性和有效性，并与后路椎间融合术进行比较。
方法
回顾性分析 2017 年 1 月至 2019 年 2 月收治的 77 例成人腰椎退行性疾病患者的临床资料，按照术中采用的融合技术分为后路椎间融合术（PLF）组（42 例）和改良关节突关节融合术（MFF）组（35 例）。比较两组患者的融合率、Oswestry 功能障碍指数（ODI）评分、腰背及下肢疼痛视觉模拟量表（VAS）评分、日本骨科协会（JOA）评分、欧洲五维健康量表（EQ-5D）评分、住院时间、手术时间、术中出血量、住院费用、并发症及再手术率。
结果
所有患者均顺利完成手术并获得随访。两组患者的年龄、性别、BMI、住院时间、手术时间、住院费用比较，差异均无统计学意义（P>0.05）。两组患者术前及术后 ODI 评分，以及 VAS、JOA、EQ-5D 评分比较，差异均无统计学意义（P>0.05）。但 MFF 组的融合率高于 PLF 组（P<0.05），术中出血量少于 PLF 组（P<0.05）。两组患者均未发生与医源性神经损伤、血管损伤、硬膜外血肿、椎间隙感染、内固定相关的并发症，均无需再次手术。
结论
改良关节突关节融合术治疗腰椎退行性疾病安全有效，融合率高于后路椎间融合术，术中出血量少于后路椎间融合术，且疗效不劣于后路椎间融合术，可在临床治疗中推广应用。
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