微创下腰椎经椎间孔椎体间融合术混合内固定治疗复发性腰椎间盘突出症的可行性研究  

A feasibility research of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） using hybrid internal fixation for recurrent lumbar disc herniation

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

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华外科杂志》2013年第8期723-727,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（50772132,50830102）;军队十二五课题资助项目（CWS11J110）

摘　　要：目的探讨微创腰椎经椎间孔椎体问融合术（MIS—TLIF）采用椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定治疗复发性腰椎间盘突出症的可行性。方法选取2010年1月至2011年12月符合纳入排除标准的16例复发性腰椎间盘突出症患者资料进行回顾性研究。其中男性10例，女性6例，年龄35～68岁，平均45岁。采用单侧切口工作通道下完成MIS—TLIF手术，在完成椎管减压、椎体间融合和单侧椎弓根螺钉内固定后，同一切口经棘突根部向对侧置入经椎板关节突螺钉，进行围手术期指标观察、影像学和疗效评价。视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评分的比较采用重复测量方差分析。结果所有患者均在工作通道下顺利完成椎管内减压、椎体间融合和混合内固定，无患者出现神经症状。平均手术时间（148±75）rain，术中出血量（186±226）ml，术后平均下床活动时间（32±15）h，平均住院日（6±4）d，手术切口长度平均（29±4）mm，经椎板关节突螺钉平均长度（52±6）mm。患者术后随访12～24个月，平均16．5个月。术后x线和cT显示混合内固定位置良好，经棘突椎板关节突螺钉均穿过椎板和关节突关节，术后随访期间腰痛和腿痛VAS与ODI评分与术前相比较均明显改善，差异有统计学意义（腰痛VAS：F=52．845，P=0．000；腿痛VAS：F=113．480，P=0．000；ODI评分：F：36．665，P=0．000）。结论单侧切口MIS—TLIF采用混合内固定可治疗复发性腰椎间盘突出症，具有创伤小、恢复快等优点。Objective To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation. Methods From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years（35-68 years） were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of pefioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale （VAS） and Oswestry disablity index （ODI）. Results All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was （ 148 ±75 ） minutes, the average operative blood loss was （186 ± 226） ml, the average postoperative ambulation time was （32 ± 15 ）hours, and the average hospitalization time was （6 ± 4） days. The average length of incision was （29 ± 4） mm, and the average length of translaminar facets screw was （52 ± 6） mm. The mean follow-up was 16. 5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points （ back pain VAS： F = 52. 845, P = 0. 000; leg pain VAS ： F = 113. 480 ,P =0. 000 ;ODI：F =36. 665 ,P =0. 000）. Conclusion Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid

关 键 词：腰椎 椎间盘移位 复发 外科手术 微创性 骨钉 内固定器 

分 类 号：R687.3[医药卫生—骨科学]