微创经椎间孔腰椎体间融合术治疗腰椎管狭窄合并腰椎不稳症  

The clinical results of minimally invasive transforaminal lumbar interbody fusion for lumbar spinal stenosis with lumbar instability

作　　者：顾广飞[1] 张海龙[1] 贺石生[1] 顾昕[1] 张立国[1] 丁悦[1] 贾建波[1] 周旭[1] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072

出　　处：《中华外科杂志》2011年第12期1081-1085,共5页Chinese Journal of Surgery

摘　　要：目的探讨微创经椎间孔腰椎间融合术（MIS-TLIF）治疗腰椎管狭窄合并腰椎不稳的临床疗效。方法对2010年3月至2011年1月42例微创通道下行单侧入路双侧减压加MIS—TLIF手术治疗的腰椎管狭窄合并腰椎不稳患者进行回顾性分析；其中男性18例，女性24例，年龄48～79岁，平均61．7岁。病变节段为L3-4例，L4～5 26例，L5—S1 12例；其中间歇性跛行伴单侧下肢症状24例，伴双侧下肢症状18例。记录手术时间、术中出血量、术后住院时间、手术并发症的情况。患者术前、术后采用视觉模拟评分（VAS）分别对腰痛及下肢痛进行评分；采用Oswestry功能障碍指数（ODI）评估腰椎功能情况及Bridwell方法评价腰椎融合情况；术后末次随访时采用MacNab标准评价疗效。结果手术时间120～170min，平均150．4min；术中出血50－400ml，平均147．1ml，无输血病例；术后住院天数5～18d，平均8．8d；术中1例出现硬膜囊撕裂，1例骨质疏松患者行椎间融合时融合器打入上位椎体中，术后3例发生切口愈合不良。随访6～14个月，平均11个月。术前腰痛VAS评分为7．3±1．0，术后3个月及末次随访时分别为2．9±0．8和2．0±0．8，与术前比较有显著改善（t=25．319和29．334，P〈0．01）；术前下肢痛VAS评分为7．9±0．7，术后3个月及末次随访时分别为2．0±0．5和1．0±0．7，与术前比较差异有显著改善（t=49．584和41．885，P〈0．01）；ODI评分术前为75％±6％，术后3个月随访时为16％±6％，末次随访时为12％±5％，与术前比较差异有统计学意义（t=43．675和56．323，P〈0．01）。末次随访时，根据Bridwell椎间融合评价标准，I级和Ⅱ级为40例（95．3％），无螺钉断裂及松动发生；采用MacNab标准评价临床效果，其中优16例，良22例，可4例。结论MIS—TLIF手术是治疗单节段腰椎管狭窄合并腰椎不稳的一种理想手术方法�Objective To investigate the clinical results of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） for lumbar spinal stenosis with lumbar instability. Methods Retrospective study was done on 42 cases of lumbar spinal stenosis with lumbar instability treated with bilateral decompression via unilateral approach and MIS-TLIF through an expandable tubular retractor from March 2010 to January 2011. There were 18 males and 24 females, and mean age was 61.7 years （rang, 48- 79 years）. The level of surgery was L3-4 in 4 patients, L4.5 in 26 patients, and L5-S1 in 12 patients. All patients had symptoms of intermittent claudication. And 24 patients had symptoms of lower extremity pain and numbness in one side, and 18 patients had same symptoms in both legs. Operation time, intra-operative bleeding, postoperative hospital stay and complications were recorded. Visual analogue scale （VAS） scores for low back pain and leg pain were recorded before and after surgery. Oswestry disability index （ ODI ） scores were also recorded before and after surgery. The Bridwell criterion was used for evaluating the interbody fusion, and the MacNab criterion was used for assessment after surgery. Results The mean operative time was 150. 4 minutes （range, 120-170 minutes） , and mean blood loss was 147.1 ml （range, 50-400 ml）. The hospitalization time after surgery was 5-18 d, an average of 8.8 d. All cases were followed- up for 6-14 months （average ll months）. VAS score of low back pain before surgery was 7.3 ± 1.0, and were 2. 9 ± 0. 8 and 2. 0 ± 0. 8 at three months after surgery and the last follow-up respectively. VAS score of leg pain before surgery was 7.9 ± 0. 7, and were 2.0 ± 0. 5 and 1.0 ± 0. 7 at three months after surgery and the last follow-up respectively. ODI score was 75% ±6% before surgery, were 16% ±6% and 12% ±5% at three months after surgery and the last follow-up respectively. VAS and ODI scores showed statistically significant improvements （ t = 3. 110-56. 323 ,P �

关 键 词：椎管狭窄 外科手术 微创性 腰椎不稳 经椎间孔腰椎椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]