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斜外侧腰椎椎间融合术对退行性腰椎椎管狭窄症患者炎症因子的影响
作者: 刘恩栗凯华吕飞王海宾韩清清张俊芬陈灵2
Authors: Liu En1, Li Kaihua1, Lyu Fei1, Wang Haibin1, Han Qingqing1, Zhang Junfen1, Chen Ling2
单位: 1冀中能源峰峰集团有限公司总医院骨科,邯郸市 056200;2白银市第一人民医院730900通信作者:刘恩,Email: y34262@126.com
Units: 1Department of Orthopedics, Jizhong Energy Fengfeng Group Hospital, Handan 056200, China; 2the First People′s Hospital of Baiyin, Baiyin 730900, China Corresponding author: Liu En, Email: y34262@126.com
关键词: 肿瘤坏死因子α;白细胞介素1α;C反应蛋白质;斜外侧腰椎椎间融合术;退行性腰椎椎管狭窄症
Keywords: Tumor necrosis factor-alpha; Interleukin-1alpha;C-reactive protein; Oblique lateral lumbar interbody fusion; Degenerative lumbar spinal stenosis
分类号:
出版年,卷(期):页码:2020,47(3):181-187
摘要:

 目的  探讨斜外侧腰椎椎间融合术(OLIF)对退行性腰椎椎管狭窄症(DLSS)患者炎症因子的影响。方法  回顾性分析2016年6月—2018年6月冀中能源峰峰集团有限公司总医院骨科收治的64 例DLSS患者的临床资料,其中男性35 例,女性29 例;年龄(60.70±6.27) 岁,年龄范围40~73 岁。根据手术方式不同分为腰椎后路减压内固定融合术(PLIF)组(n=32)和OLIF组(n=32)。比较术前、术后3 个月及末次随访两组患者手术时间、术中出血量、术后卧床时间、住院时间、腰腿疼痛视觉模拟评分法(VAS)、腰椎日本骨科协会(JOA)评分及血清炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素1α(IL-1α)、C反应蛋白(CRP)]水平。采用门诊或电话方式进行随访,随访时间截至2019年3月。计量资料以均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验或重复测量数据的方差分析,组内比较采用配对t检验。计数资料以百分比(%)表示,用χ2检验。结果  OLIF组的手术时间与PLIF组比较差异无统计学意义(P>0.05);OLIF组术中出血量(119.72±30.41) mL、术后卧床时间(2.16±0.35) d、术后住院时间(5.18±2.06) d均显著低于PLIF组[(318.26±94.62)  mL,(3.17±0.54)  d,(7.35±1.24)  d],两组比较差异具有统计学意义(P<0.05)。所有患者均获得8个月的随访时间,术后3 个月和末次随访OLIF组腰疼痛VAS评分[(1.93±0.54)  分,(1.74±0.63)  分]显著低于PLIF组[(4.05±0.62)  分,(3.87±0.74)  分],腿疼痛VAS评分[(1.56±0.71)  分,(1.37±0.52)  分]显著低于PLIF组[(3.74±0.79)  分,(2.53±0.59)  分],腰椎JOA评分[(22.57±1.83)  分,(24.38±1.65)  分]显著高于PLIF组[(20.35±1.78)  分,(22.14±1.35)  分],两组比较差异具有统计学意义(P<0.05)。术后3 个月OLIF组血清TNF-α(16.95±3.92) ng/L、IL-1α(9.17±3.78) ng/L及CRP(1.97±0.24) mg/L水平均显著低于PLIF组[(20.46±4.27) ng/L,(11.51±4.25) ng/L,(2.36±0.32) mg/L](P<0.05);末次随访OLIF组血清TNFα(13.47±3.54) ng/L、IL-1α(6.52±2.09) ng/L及CRP(1.42±0.16) mg/L水平均显著低于PLIF组[(18.08±3.84) ng/L,(8.73±5.43) ng/L,(2.04±0.25) mg/L],两组比较差异具有统计学意义(P<0.05)。结论  与PLIF相比,OLIF治疗DLSS能够降低术中出血量、缩短患者恢复时间,同时降低患者术后炎症因子表达水平,改善患者预后。

 Objective  To investigate the effect of oblique lateral lumbar intervertebral fusion (OLIF) on inflammatory factors in patients with degenerative spinal canal stenosis (DLSS). Methods  Retrospective analysis of clinical data of 64 DLSS patients in the department of orthopedics, Jizhong Energy Fengfeng Group Hospital from June 2016 to June 2018 was performed. There were 35 males and 34 females, aged (60.70±6.27) years, and the age range was 20 to 80 years. According to the different surgical methods, they were divided into posterior decompression and internal fixation fusion (PLIF) group (n=32) and OLIF group (n=32). The coperation time, intraoperative bleeding volume, postoperative bed rest time, hospitalization time , the back and leg pain  visual analogue score (VAS) , Japanese Orthopaedic Association(JOA) score of lumbar vertebrae  and serum inflammatory factors [tumor necrosis factor-alpha(TNF-α), interleukin-1alpha(IL-1α), C-reactive protein(CRP)]  were observed at preoperative, 3 months and last follow-up. Follow-up using outpatient examination and telephone interview was performed  and survial up to March 2019. Measurement data were expressed as mean±standard deviation (Mean±SD),  comparison between groups was performed using independent sample t test or analysis of variance of repeated measurement data. Internal comparisons were performed using paired t tests. Count data were expressed as percentage (%), and χ2 test was used. Results  There was no significant difference in operation time between OLIF group and PLIF group (P>0.05). In OLIF group, the amount of blood loss (119.72±30.41)  mL, bedridden time (2.16±0.35)  d and postoperative hospital stay (5.18±2.06)  d were significantly lower than that of PLIF group[(318.26±94.62) mL, (3.17±0.54) d, (7.35±1.24) d], the differences between the two groups were statistically significant(P<0.05). All patients were followed for 8 months. The 3 months after operation and last follow-up, the VAS scores of back pain in OLIF group [(1.93±0.54) scores, (1.74±0.63) scores]were significantly lower than that in PLIF group [(4.05±0.62) scores, (3.87±0.74) scores]. The VAS scores of leg pain in OLIF group [(1.56±0.71) scores, (1.37±0.52) scores] were significantly lower than that of PLIF group [(3.74±0.79) scores, (2.53±0.59) scores]. The JOA scores of lumbar vertebrae in PLIF group [(22.57 ±1.83) scores, (24.38±1.65) scores] were significantly higher than that of PLIF group [(20.35±1.78) scores, (22.14±1.35) scores], the differences between the two groups were statistically significant(P<0.05). At 3 months after operation, the levels of serum TNF-α(16.95±3.92) ng/L, IL-1α(9.17±3.78) ng/L and CRP (1.97±0.24) mg/L in OLIF group were significantly lower than those in PLIF group [(20.46 ±4.27) ng/L, (11.51±4.25) ng/L, (2.36±0.32) mg/L]. Last followup, the level of serum TNFα(13.47±3.54) ng/L, IL-1α(6.52±2.09) ng/L and CRP (1.42±0.16) mg/L in the OLIF group were significantly lower than those in the PLIF group [(18.08±3.84) ng/L, (8.73±5.43) ng/L, (2.04±0.25) mg/L], the differences between the two groups were statistically significant (P<0.05). Conclusion  Compared with PLIF, OLIF can reduce the amount of intraoperative bleeding, shorten the recovery time, reduce the expression of inflammatory factors and improve the prognosis of patients with DLSS.

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