单枚与双枚椎间融合器在椎间孔镜下治疗腰椎失稳中的临床疗效比较

Clinical efficacy comparison of single and two interbody fusion devices in treatment of lumbar instability under intervertebral foraminoscopy

摘要:

目的 比较腰椎间隙植入单枚与双枚融合器在椎间孔镜下治疗腰椎失稳的临床疗效和安全性。方法 选取2019年1月－2022年6月该院诊断为L₄、L₅或S₁节段Ⅰ°至Ⅱ°滑脱，采用椎间孔镜行椎间融合器植入、经皮椎弓根螺钉和钉棒系统固定的患者101例（101个椎体），按照随机原则将患者分为A组（单枚融合器组）和B组（双枚融合器组）。其中，A组51例，51个椎体滑脱，B组50例，50个椎体滑脱。于术后1周、术后1个月、术后6个月、术后9个月和术后15个月对患者进行随访，比较两组患者滑脱距离、椎间隙高度、椎间隙融合情况、椎体沉降率、腰椎疼痛视觉模拟评分法（VAS）评分和腰椎Oswerry功能障碍指数（ODI）等的差异。结果 101例患者均获得全程随访，两组患者住院时间、手术时间、术中出血量和术后引流量比较，差异均无统计学意义（P > 0.05）；术后1周，A组VAS评分为（7.32±0.57）分，B组为（7.14±0.61）分，两组患者比较，差异无统计学意义（P > 0.05）；术后6个月，A组ODI为（27.44±9.52）%，B组为（21.89±8.46）%，两组患者比较，差异无统计学意义（P > 0.05）；术后6、9和15个月随访时，A组椎间隙融合率分别为11.76%、68.63%和90.20%，B组椎间隙融合率分别为18.00%、80.00%和96.00%，两组患者比较，差异均有统计学意义（P < 0.05）；术后15个月随访时，A组椎间隙高度为（0.45±0.07）cm，明显小于B组的（0.58±0.06）cm，两组患者比较，差异有统计学意义（P = 0.038）；A组术后椎体滑脱距离为（0.33±0.18）mm，与B组的（0.28±0.21）mm比较，差异无统计学意义（P = 0.079）。结论 植入双枚融合器可以提供更多的接触面积和更佳的稳定性，缩短椎体融合时间，增加椎体融合率，减少椎体沉降的发生。值得临床推广应用。

Abstract:

Objective To compare the clinical efficacy and safety of lumbar intervertebral space implantation with single and two fusion devices in treatment of lumbar instability under intervertebral foraminoscopy.Methods 101 patients (101 vertebral bodies) diagnosed with L₄, L₅ or S₁ segment I° to II° spondylolisthesis from January 2019 to June 2022 were enrolled and the patients were randomly divided into group A (single fusion device group) and group B (double fusion devices group) by intervertebral foraminoscopy. Among of them, there were 51 cases of vertebral spondylolisthesis in group A and 50 cases of vertebral spondylolisthesis in group B. The patients were followed up at 1 week, 1 month, 6 months, 9 months and 15 months after surgery, and the differences in spondylolisthesis distance, intervertebral space height, intervertebral space fusion, vertebral sedimentation rate, lumbar pain visual analogue scale (VAS) and lumbar Oswerry disability index (ODI) between the two groups were compared.Results All the 101 patients were followed up throughout the whole process, and there were no significant differences in operation time, intraoperative blood loss, and postoperative drainage between the two groups (P > 0.05), and the VAS was (7.32 ± 0.57) in group A and (7.14 ± 0.61) in group B one week after operation, there was no significant difference between the two groups (P < 0.05). At 6 months after surgery, the ODI of group A was (27.44 ± 9.52)% and group B was (21.89 ± 8.46)%, and there was no significant difference between the two groups (P > 0.05). And at 6, 9 and 15 months follow-up, the fusion rates of group A were 11.76%, 68.63% and 90.20%, respectively, and the fusion rates of group B were 18.00%, 80.00% and 96.00%, respectively, and there was significant difference between the two groups (P < 0.05). At 15 months postoperative follow-up, the intervertebral space height of group A (0.45 ± 0.07) cm was significantly smaller than that of group B (0.58 ± 0.06) cm, and the difference was statistically significant (P = 0.038). There was no significant difference between group A and group B (0.33 ± 0.18) mm and (0.28 ± 0.21) mm (P = 0.079) of spondylolisthesis distance.Conclusion Implantation of the double fusion devices can provide more contact area and better stability, shorten the vertebral fusion time, increase the vertebral fusion rate, and reduce the occurrence of vertebral settlement. It is worthy of clinical promotion and application.