Abstract：Objective: To investigate the clinical efficacy of posterior fenestration, decompression, orthopedic fusion and internal fixation (PLIF) in the treatment of DLSS combined with LS. Methods: 109 patients with DLSS and LS were randomly divided into observation group (n=55) and control group (n=54). The control group was treated with total laminectomy (LAM) and intervertebral fusion IF, and the observation group was treated with PLIF. The effects of different surgical methods on lumbar stability, sagittal spine morphology lumbar dysfunction were compared. And complications were recorded. Results: There was a significant difference between the two groups in terms of vertebral fusion one year after operation (P<0.05). The intraoperative blood loss in the observation group was significantly lower than that in the control group, the operation, bed rest and hospitalization time were lower than that in the control group, and the incision length was shorter than that in the control group (P<0.05). After surgery, lumbar lordosis angle (LL), shapeless vertical axis (SVA), pelvic incidence (PI), thoracic kyphosis angle (TK) and pelvic tilt angle (PT) in both groups were significantly decreased, but there was no significant difference between the two groups in the above indexes before and after operation (P>0.05). After operation, the spinal dysfunction score (ODI) and pain score (VAS) of the two groups were significantly decreased, and the human dysfunction score (JOA), intervertebral space height, intervertebral foramen height, and lumbar lordosis angle were increased. The difference of the above indexes before and after operation between the two groups was statistically significant (P<0.05) Conclusion: In the clinical treatment of patients with DLSS and LS, PLIF and LAM interbody fusion IF have the same effect in spinal canal fusion and spinal morphology improvement, but the former has less trauma, low pain and less blood loss, and can effectively promote the recovery of limb function, which is worthy of clinical promotion.
[1] 杨进,王玉,孔清泉.腰椎侧方椎管狭窄分型在全内镜减压治疗老年退变性腰椎管狭窄症的应用[J].中国修复重建外科杂志,2020,34(4):415-421. [2] 潘玉军,时长江,孙贺.不同手术方式治疗合并退行性腰椎侧弯腰椎管狭窄症的临床疗效及远期安全性评估[J].中国老年学杂志,2022,42(9):2147-2150. [3] 金辉,金才益,曾忠友,等.腰椎退行性病变腰椎后路融合内固定术后融合器后移的处理[J].中国骨与关节损伤杂志,2020,35(5):502-203. [4] 刘俊麟,孔清泉,冯品,等.经皮同轴大通道内镜下与微创经椎间孔入路腰椎椎间融合术治疗退变性腰椎管狭窄症疗效比较[J].中国修复重建外科杂志,2022,36(6):681-690. [5] Shimizu T,Fujibayashi S,Otsuki B,et al.Indirect decompression via oblique lateral interbody fusion for severe degenerative lumbar spinal stenosis: a comparative study with direct decompression transforaminal/posterior lumbar interbody fusion[J].Spine,2021,21(6):963-971. [6] 王国新,罗宝宁,马友才.开窗减压术与全椎板切除椎间融合内固定术治疗腰椎椎管狭窄的疗效及安全性分析[J].实用医院临床杂志,2020,17(4):227-230. [7] 刘大旭,张艳锋,范兆阳.腰椎退行性疾病经后路减压融合术后发生症状性邻近节段退变的预测因素[J].颈腰痛杂志,2021,42(1):70-72. [8] Choi S H,Koo J W,Choe D H,et al.Interbody fusion in degenerative lumbar spinal stenosis with additional posterolateral fusion using escherichia coli-derived bone morphogenetic protein-2: a pilot study[J].Medicine (Baltimore),2020,99(24):20477. [9] Sielatycki J A,Devin C J,Pennings J,et al.A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year[J].Spine,2021,21(5):829-840.
2022, Vol. 28 
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