内镜下单节段后路腰椎椎体间融合术临床分析  

Clinical assessment of one-level posterior lumbar interbody fusion performed with microendoscopic approach

作　　者：王运涛[1] 吴小涛[1] 陈辉[1] 李永刚[1] 洪鑫[1] 

机构地区：[1]东南大学中大医院骨科,南京市210009

出　　处：《中华显微外科杂志》2007年第6期413-416,I0002,共5页Chinese Journal of Microsurgery

基　　金：江苏省卫生厅社会发展基金项目(H200759:)

摘　　要：目的探讨内镜下后路腰椎椎间融合术(PLIF)治疗腰椎单节段病变的临床应用价值。方法从2005年1月到2006年5月共进行PLIF手术56例,其中内镜下手术24例、传统开放手术32例。随访时间12～27个月,平均17.4个月。对比术中出血量、术后引流量、术中术后异体血回输量、手术时间及术后住院日;对比腰痛视觉模拟疼痛评分(VAS)及日本矫形外科协会(JOA)下腰痛评分;观察并发症的发生及术后椎间融合情况。结果内镜组术中出血量、术后引流量、术中术后异体血回输量、术后住院日均少于开放组(P<0.05);而手术时间(203.8±38.1)min较开放组(181.4±34.6)min稍长(P=0.026)。内镜组术后腰痛VAS均较开放组低(P<0.05),其中术后第4天、第9天差异有统计学意义(P<0.01)。内镜组术后优良率为87.5%(21例),并发症发生率为8.3%(2例),椎问融合率为100%(24例),与开放组相比差异无统计学意义(P>0.05)。结论内镜下PLIF手术具有出血少、创伤反应小、术后疼痛轻、恢复快、术后住院日短等优点,在适应证选择合适的情况下,临床疗效确切。Objective To evaluate the clinical outcome of one-level posterior lumbar interbody fusion （PLIF） performed with microendoscopic approach. Methods A consecutive series of 56 patients who under went one-level PLIF procedure（24 cases performed with microendoscopic approach and 32 cases with traditional open approach）were studied from January 2005 to May 2006. The following data were compared between 2 groups with 12 to 27 months follow-up： estimated blood loss, postoperative drainage, transfusion needs, surgical time, length of hospital stay, postoperative back pain by visual analogue scale, complications, and the clinical and radiographic results. Results The microendoscopic approach was found to have a significantly less blood loss, less postoperative drainage, less needs of transfusion, less postoperative back pain, shorter recovery time and shorter length of hospital stay. However, the microendoscopic approach needed significantly longer surgical time. There was no significant difference between 2 groups in the aspects of the complications and the clinical and radiographic results. Conclusion The one-level PLIF performed with microendoscopic approach minimize estimated blood loss, length of hospital stay, postoperative back pain. It also shows the excellent surgical efficacy of the microendoscopic approach for suitable patients.

关 键 词：内镜 脊柱外科 椎体间融合术 腰椎 

分 类 号：R687.3[医药卫生—骨科学]