单侧切口微创经椎间孔腰椎椎间融合术混合内固定治疗双节段腰椎退行性疾病  

A FEASIBILITY RESEARCH OF MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION USING UNILATERAL INCISION AND HYBRID INTERNAL FIXATION FOR DURAL-LEVEL LUMBAR DEGENERATIVE DISEASE

作　　者：徐教[1] 毛克亚[1] 王岩[1] 肖嵩华[1] 李鹏[1] 毛克政[1] 肖波[1] 王义国[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中国修复重建外科杂志》2013年第8期955-959,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(50830102);国家高技术研究发展计划(863)资助项目(2009AA02Z405);全军医学科研"十二五"课题计划资助项目(CWS11J110)~~

摘　　要：目的探讨采用单侧切口微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbarinterbody fusion,MIS-TLIF)以椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定治疗双节段腰椎退行性疾病的可行性及临床疗效。方法 2010年1月-2012年1月,收治19例双节段腰椎退行性疾病患者。男7例,女12例;年龄22～68岁,平均50.4岁。病程8个月～15年,中位病程37个月。手术节段:L3～56例,L4～S113例。在单侧切口工作通道下完成MIS-TLIF手术,采用椎弓根螺钉结合对侧经椎板关节突螺钉双侧混合内固定。结果患者均顺利完成手术,平均手术时间158 min、术中出血量156 mL、切口长度42 mm、术后下地时间35 h、住院时间4.1 d、经椎板关节突螺钉长度51 mm。术后切口均Ⅰ期愈合;除1例术中硬膜撕裂外,未出现其他并发症。19例均获随访,随访时间12～24个月,平均17.1个月。术后各时间点腰痛视觉模拟评分(VAS)、腿痛VAS评分及Oswestry功能障碍指数(ODI)评分均较术前显著改善(P<0.05);且随时间延长症状逐渐缓解。术后X线片示内固定物位置良好,经椎板关节突螺钉均穿过棘突根部、椎板和关节突关节,其中2枚(5.3%)经椎板关节突螺钉穿透椎板外侧皮质,1枚(1.8%)椎弓根螺钉略偏出椎弓根外,但均无神经损伤症状。术后12个月CT平扫及三维重建显示椎体间骨性融合良好;根据Bridwell椎间融合评价标准评价,Ⅰ级11例,Ⅱ级8例。结论采用单侧切口MIS-TLIF混合内固定治疗双节段腰椎退行性疾病安全可行,具有手术时间短、创伤小、出血少及恢复快等优点。Objective To investigate the feasibility and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion（MIS-TLIF） using unilateral incision and internal fixation of pedicle screws and a translaminar facet screw for dural-level lumbar degenerative disease. Methods Between January 2010 and January 2012,19 patients with dural-level lumbar degenerative disease was treated,including 7 males and 12 females with an average age of 50.4 years（range,22-68 years） and a median disease duration of 37 months（range,8 months to 15 years）.The operated segments included L3-5 in 6 cases and L4-S1 in 13 cases.MIS-TLIF was performed by unilateral incision,and then pedicle screws and a translaminar facet screw were used for internal fixation. Results Operations were successfully performed in all cases.The mean operation time was 158 minutes;the mean intraoperative blood loss was 156 mL;the mean length of incision was 42 mm;the mean postoperative ambulation time was 35 hours;the mean hospitalization time was 4.1 days;and the mean length of translaminar facet screw was 51 mm.All the wounds healed by first intention.No complication occurred in the others except 1 case of dural tear.The patients were followed up 12-24 months（mean,17.1 months）.The visual analogue scale（VAS） scores for back and leg pain and Oswestry disability index（ODI） scores at postoperation were significantly improved when compared with preoperative ones（P 0.05）.The symptom disappeared gradually.The postoperative X-ray images showed that the internal fixations were in good position;all facets screws penetrated through the base of spinous process,laminar,and facets joint;of the screws,2 （5.3%） facets screws penetrated lateral laminar,and 1（1.8%） pedicle screw penetrated out of pedicle of vertebral arch,but no symptom of nerve injury was seen.The CT scan and three-dimensional reconstruction at postoperative 12th month showed good interbody fusion;and based on the Bridwell＇s interbody fusion grading system,11 cases

关 键 词：微创经椎间孔腰椎椎间融合术 单侧切口 混合内固定 双节段腰椎退行性疾病 

分 类 号：R687.3[医药卫生—骨科学]