微创手术治疗单节段腰椎管狭窄症的疗效评价  

Outcomes of minimally invasive treatment for single level lumbar stenosis

作　　者：毛克亚[1] 王岩[1] 肖嵩华[1] 张永刚[1] 刘保卫[1] 张西峰[1] 崔庚[1] 张雪松[1] 程自申[1] 李鹏[1] 

机构地区：[1]中国人民解放军总医院骨科,北京市100853

出　　处：《中国脊柱脊髓杂志》2011年第2期113-117,共5页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金(编号:39670731);国家863计划(编号:2009AA02Z405)

摘　　要：目的:对比微创手术与传统开放手术治疗单节段腰椎管狭窄症的临床效果,评价微创手术治疗腰椎管狭窄症的安全性和有效性。方法:2008年1月～2009年1月收治43例单节段腰椎管狭窄症患者,其中28例采用传统开放减压、后路椎体间融合手术(posterior interbody fusion,PLIF)治疗(A组),15例采用微创减压、经椎间孔融合手术(transforaminal lumbar interbody fusion,TLIF)治疗(B组),比较两组患者的手术时间、术中C型臂X线机照射时间、术中出血量、术后引流量、术后下地时间和术后平均住院时间,并分别采用Oswestrydisability index(ODI)、visual analogue scores(VAS)和X线评价治疗效果。结果:所有患者均获得随访,两组术前一般资料、VAS和ODI评分无显著性差异。B组手术时间和术中透视时间多于A组(P<0.01),而术中出血量和术后引流量B组明显低于A组(P<0.01),术后下地活动时间和术后平均住院日B组明显短于A组(P<0.01)。术后5d时VAS评分B组优于A组(P<0.05),而其他时间相比两组VAS评分与ODI评分相比均无显著性差异(P>0.05),术后X线评价融合率两组亦无显著性差异(P>0.05)。结论:与传统开放手术相比,微创手术治疗单节段腰椎管狭窄症,同样可以获得安全、有效的治疗结果,并且在手术出血量、术后引流量、术后下地活动时间和术后住院时间方面优于传统开放手术。Objective：To compare the clinical outcomes of minimally invasive surgery（MIS） and open surgery for single-level lumbar stenosis and to evaluate the safety and reliability of MIS for single-level lumbar stenosis.Method：From Jan 2008 to Jan 2009,15 patients with single level lumbar stenosis underwent single-level MIS decompression and transforaminal lumbar interbody fusion（TLIF）,while 45 cases with the same problems underwent traditional open decompression and posterior lumbar interbody fusion（PLIF）.The operative time,X-ray exposure time,pereoperative blood loss,postoperative ambulation,and bed time were compared between two groups.Futhermore,clinical outcomes in terms of Oswestry Disability Index（ODI）,back and leg pain Visual Analogue scores（VAS）,and X-ray examination were performed before surgery,after surgery and during follow-up.Result：There was no difference with respect to preoperative demographic data,VAS and ODI scores between two groups.MIS group had longer operative time and X-ray exposure time than open group（P〈0.01）,but less pereoperative blood loss than open group（P〈0.01）.MIS group had shorter postoperative bed time than open group（P〈0.01）.The VAS score of back pain at 5th day postoperative in MIS group was higher than open group（P〈0.05）.There was no difference between two groups with respect to VAS and ODI scores at other timepoints.No difference for lumbar fusion rate was noted between two groups.Conclusion：MIS and open groups can achieve similar safety and reliability,but as for the pereoperative blood loss,postoperative bed time,MIS group is superior than open group.

关 键 词：腰椎管狭窄症 微创手术 开放手术 治疗效果 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]