微创和开放椎间融合治疗单节段腰椎间盘突出症  

Minimally invasive versus open transforaminal lumbar interbody fusion in the treatment of single-level lumbar disc herniation

作　　者：丁茹虎[1] 刘波[2] 张波[2] 王永庆[2] 肖斌[2] 苏海涛 

机构地区：[1]北京市怀柔区第一医院骨科,北京市101400 [2]北京积水潭医院脊柱科,北京市100035 [3]营口市中心医院骨1科,辽宁省营口市115002

出　　处：《中国组织工程研究》2013年第30期5452-5459,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:导航辅助微创腰椎后路椎弓根螺钉及椎间融合器内固定可以实时精确引导微创套筒下各种操作,安全准确置入椎弓根螺钉及椎间融合器等各种内置物,并可以确定减压部位。微创经椎间孔椎间融合是近年来微创脊柱外科技术成功应用的典型代表,具有切口小、出血少、组织损伤轻和恢复快等显著优点。目的:评价即时三维导航下单节段微创经椎间孔椎间融合与开放后路椎间融合的短期临床疗效比较。方法:回顾性分析40例单节段腰椎间盘突出症患者资料,40例患者分别采用即时三维导航下微创经椎间孔椎间融合(20例)和开放后路椎间融合(20例)术式进行对比研究。比较两组融合时间、融合过程中出血量、融合后引流量、治疗后住院时间与总住院时间,疼痛目测类比评分和腰椎疾患疗效评分、治疗后伤口疼痛及功能情况。结果与结论:40例均获得平均7.7个月随访,微创经椎间孔椎间融合组平均手术时间较开放后路椎间融合组长,差异有非常显著性意义(P<0.01),微创经椎间孔椎间融合组总的住院时间、治疗后住院时间较开放后路椎间融合组缩明显缩短,差异有非常显著性意义(P<0.01);微创经椎间孔椎间融合过程中出血量明显较开放后路椎间融合减少,差异有显著性意义(P<0.05);治疗后引流量也明显少于开放后路椎间融合组,差异有非常显著性意义(P<0.01);与后路椎间融合组比较,内固定后3d微创经椎间孔椎间融合组腰痛疼痛目测类比评分明显降低,腰椎疾患疗效评分明显升高,差异均有非常显著性意义(P<0.01);但治疗前、治疗后6个月两组腰、腿痛疼痛目测类比评分和腰椎疾患疗效评分比较,差异无显著性意义(P>0.05)。说明即时三维导航下单节段微创经椎间孔椎间融合具有术中出血量少、治疗后引流少、创伤小、住院时间短、短期疗效确切等优点,是一种有效的治疗方BACKGROUND：Navigation assisted minimal y invasive posterior lumbar interbody fusion and pedicle screw fixation can precisely real-time guide a variety of operation under minimal y invasive sleeve, and implant the pedicle screws and interbody fusion cage and other implants safely and accurately, thus can determine the decompression parts. Minimal y invasive transforaminal lumbar interbody fusion is the typical approach in recent years for the successful application of minimal y invasive spine surgery techniques with the advantages of smal incision, less bleeding, slight tissue damage and faster recovery. OBJECTIVE：To evaluate the short-term effect of minimal y invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system and open posterior transforaminal lumbar interbody fusion. METHODS：Forty cases with single-level lumbar disc herniation were retrospectively analyzed. The patients were treated with minimal y invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system （20 cases） and open posterior transforaminal lumbar interbody fusion （20 cases） respectively for the comparative analysis. The fusion duration, intraoperative blood loss, postoperative drainage volume, the length of postoperative hospital stay and the length of hospital stay were compared between two groups. The wound pain and function were evaluated after treatment with visual analogue scale score and Japanese Orthopaedic Association score. RESULTS AND CONCLUSION：Al patients were fol owed-up for 7.7 months. The operative duration in the minimal y invasive transforaminal lumbar interbody fusion group was longer than that in the open posterior transforaminal lumbar interbody fusion group, and the difference was significant （P〈0.01）;the length of hospital stay and length of postoperative hospital stay of the minimal y invasive transforaminal lumbar interbody fusion group were shorter than the open posterior transforaminal lumbar interbody fusion group, and

关 键 词：骨关节植入物 脊柱植入物 腰椎间盘突出症 三维导航 微创 椎间融合 疼痛目测类比评分 腰椎疾患疗效评分 单节段 内固定 

分 类 号：R318[医药卫生—生物医学工程]