微创TLIF单侧或双侧固定治疗腰椎退行性疾病的临床疗效  

The clinical outcomes of minimally invasive unilateral or bilateral TLIF for lumbar degenerative disease

作　　者：邹海波[1] 绳厚福[1] 李中实[1] 陈栋[1] 赵景鑫[1] 

机构地区：[1]北京中日友好医院脊柱外科,北京市100029

出　　处：《中国脊柱脊髓杂志》2013年第12期1086-1091,共6页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：评价微创通道下经椎间孔腰椎椎体间融合术（TLIF）单侧或双侧固定治疗腰椎退行性疾病的临床疗效。方法：2011年1月．2012年11月应用MastQuadrant通道对52例单节段腰椎退变性疾病的患者经椎旁多裂肌入路行TLIF单侧（31例）或双侧（21例）固定治疗。男27例，女25例，年龄30—77岁，平均52．9岁。观察二种固定方式在手术时间、术中失血量、术后住院时间及手术费用的差别。采用Oswestry功能障碍指数评分（ODI）和疼痛视觉模拟评分（VAS）评价临床疗效。通过影像学测量手术节段Cobb角（矢状位）及不同部位椎间隙的高度，观察手术前后影像学变化并评价椎体间融合情况。结果：所有患者随访3～18个月，平均12个月。两组患者在手术时间、术后住院时间及手术费用方面差异有统计学意义（P〈0．01）。全部患者ODI平均值由术前的（67．67±18．59）％降至末次随访时的（25．58±20．80）％，VAS腰痛评分平均值由术前的（7．42±2．48）分降至末次随访时的（2．09±2．47）分，VAS腿痛评分平均值由术前的（8．04±1．22）分降至末次随访时的（2．46±2．07）分，手术前后差异均有显著的统计学意义（P〈0．001）。单侧及双侧固定组在手术前后的ODI、VAS评分差异无统计学意义（P〉0．05）。全部患者手术后的影像学测量指标均较术前改善，且差异有统计学意义（P〈0．05）。单侧及双侧固定组在手术前后影像学测量指标差异无统计学意义（P〉0．05）。除1例双侧固定患者术后出现单侧下肢症状而进行螺钉调整外，至末次随访时，所有患者均达到影像学融合标准，未发现椎弓根螺钉松动、断裂或cage移位等并发症的发生。结论：无论是单侧还是双侧固定，微创通道下经椎间孔椎体间融合术都可以有效缓解患者的临床症状。如适应证选择正确，单侧固定具有手Objectives： To evaluate the clinical outcomes of minimally invasive unilateral or bilateral trans- foraminal lumbar interbody fusion （TLIF） for lumbar degenerative disease. Methods： From January 2011 to November 2012, 52 patients with single-level lumbar degeneration disease were treated through mini-TLIF for unilateral（31 cases） and bilateral（21 cases） pedicle screw fixation assisted by Mast Quadrant. The average age of patients was 52.9 years（ranged, 30-77）, including 27 males and 25 females. The operation time, in- traoperative blood loss, postoperative hospital stay and surgical cost were recorded. The pre- and post-opera- tive clinical outcomes were assessed by visual analogue scale（VAS） and Oswestry disability index（ODI）. The pre- and post-operative radiologic parameters were compared which included the sagittal Cobb angle and the disc height. Results： The mean follow-up time was 12 months（ranged, 3-18）. There were significant differ- ences between two groups on operation time, hospital stay and surgical cost（P〈0.01）. The ODI of all patients decreased from （67.67-＋18.59）% to （25.58_＋20.80）%. The VAS improved from 7.42_＋2.48 to 2.09_＋2.47 for low back pain and from 8.04-＋1.22 to 2.46-＋2.07 for leg pain. There were significant differences with respect to the improvement rate of ODI and VAS for all patients （P〈0,001）. There was no statistical deference between pre- and post-operative ODI and VAS scores for each group（P〉0.05）. The postoperative radiologic indexes of all patients were higher than the preoperative ones（P〈0.05）. But no statistical difference of radiologic indexes between preoperation and final follow-up for each group was noted（P〉O.05）. Except one patient with bilateral fixation adjusted pedicle screw because of leg pain after operation, at final follow-up, all the patients achieved radiographic fusion without instrument failure and other complications. Conclusions： Mini-TLIF through Mast Quadrant regardless of u

关 键 词：腰椎 退行性疾病 手术 微创 

分 类 号：R681.5[医药卫生—骨科学]