目的 探讨经椎间孔微创椎间融合联合对侧经皮椎弓根螺钉内固定治疗腰椎退行性疾病的临床疗效。方法 选择2013-03至2016-12医院手术治疗的64例腰椎退行性疾病患者,随机分为微创组和传统组,每组32例,记录两组的手术时间、术中出血量、术后引流量、住院天数, 并比较术前、术后疼痛视觉模拟VAS评分、Oswestry功能障碍指数的临床功能ODI评分。结果 微创组手术时间为(132.03±21.73)min,术中出血量为(186.39±51.32)ml,术后引流量为(64.17±31.71)ml,术后住院天数为(7.30±1.06)d,与传统组相比,手术时间短、出血量少、住院时间短,差异有统计学意义(P<0.05)。两组手术前后VAS、ODI评分比较,微创组均优于传统组,差异均有统计学意义(P<0.05)。结论 微创经椎间孔椎间融合联合对侧经皮椎弓根螺钉治疗腰椎退行性疾病,具有出血少、软组织损伤小、术后疼痛轻和住院时间短的优点,值得临床推广。
Abstract
Objective To explore the clinical effect of minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for the treatment of lumbar degenerative disease, and compare this approach with a conventional one. Methods Between March 2013 and December 2016, 64 patients with lumbar degenerative disease were treated,23 with minimally invasive transforaminal lumbar interbody fusion through expandable channel and percutaneous pedicle screw fixation(MI-TLIF),and the rest with the conventional approach(TLIF). The duration of surgery, intraoperative blood loss ,postoperative draining loss and hospital stay were recorded.The clinical effects were evaluated according to the visual analog scale(VAS) and Oswestry Disability Index(ODI)scores. Results In the MI-TLIF group, the duration of surgery was (132.03±21.73)min,intraoperative bleeding (186.39±51.32)ml,surgical draining loss(64.17±31.71)ml,and hospital stay was (7.30±1.06)d, compared with (115.26±30.14)min,(279.13±42.65)ml,(145.14±58.12)ml,and (11.52±2.38)d in the TLIF group. The MI-TLIF group had less blood loss and shorter hospital stay, so there was significant difference between the two groups(P<0.05).The postoperative VAS and ODI scores improved significantly(P<0.05),especially at early stage. Conclusions Lumbar degenerative diseases can be effectively treated with minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation. This approach causes less blood loss ,less soft tissue injury, low postoperative pain and fewer complications,which is worthy of application.
关键词
经椎间孔椎体间融合 /
微创性 /
经皮 /
内固定 /
退行性腰椎疾病
Key words
transforaminal lumbar interbody fusion /
minimally invasive /
percutaneous /
internal fixation /
lumbar degenerative disease
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Kim C W. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery[J]. Spine, 2010, 35(26S): S281-286.
[2] Hu Z J,Fang X Q,Fan S W.Iatrogenic injury to the erector spine during posterior lumbar spine surgery:underlying anatomical considerations,preventable root causes,and surgical tips and tricks[J].Eur J Orthop Surg Traumatol, 2014, 24(2): 127-135.
[3] 袁 渤,杜明奎.脊柱微创技术的现状与展望[J].武警医学,2017,28(9):946-949.
[4] Liu J,Deng H,Long X,et al. A comparison study of perioperative complications between transforaminal versus lumbar interbody fusion in degenerative lumbar spondylolisthesis[J]. Eur Spine,2016,25(5):1575-1580.
[5] 高松森,曹 云,陶 晖,等.经椎间孔椎体间融合术与经后路椎体间融合术治疗轻、中度退变性腰椎滑脱症临床疗效及安全性的Meta分析[J].中国脊柱脊髓杂志,2018,28(1):16-24.
[6] 郑 扬,李危石,陈仲强,等.微创与开放经椎间孔腰椎间融合术治疗腰椎单节段退行性疾病的临床疗效比较[J],中国脊柱脊髓杂志,2014,24(12):1064-1071.
[7] 范顺武,胡志军,方向前,等.小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究[J].中华骨科杂志,2009,29(11):1000-1004.
[8] Stevens K J, Spenciner D B, Griffiths KL,et al.Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pression studies[J] . J Spinal Disord Tech,2006,19(2):77-86.
[9] 任忠明,吴宏飞,张 远,等. 肌间隙入路与传统入路椎弓根螺钉内固定治疗胸腰段骨折[J].中华创伤杂志,2013,29(9):845-848.
[10] Peng C W,Yue W M,Poh S Y,et al.Clinical and radiological out-comes of minimally invasive versus open transforaminal lumbar interbody fusion[J].Spine,2009,34(13):1385-1389.
[11] 刘新宇,原所茂,田永昊,等. 微创经椎间孔腰椎椎间融合在腰椎退行性疾病翻修中的应用[J],中华骨科杂志,2017,37(3):137-144.
PDF(935 KB)
