MIS-TLIF与PLIF治疗单节段退行性腰椎疾病的肌肉损伤比较  

Comparison of degree of postoperative muscle damage between MIS-TLIF- and PLIF treatment for single-level degenerative lumbar disease

作　　者：周亮[1] 刘郑生[1] 毛克亚[1] 刘建恒[1] 肖波[1] 徐教[1] 王义国[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《解放军医学杂志》2013年第12期972-975,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金面上项目(51372276);军队"十二五"医学科研基金面上项目(CWS11J110)~~

摘　　要：目的比较传统开放性后路腰椎椎间融合术(PLIF)与扩张通道管(X-Tube)辅助微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗单节段退行性腰椎疾病的肌肉损伤情况。方法回顾性分析2010年10月-2011年9月,采用X-Tube辅助MIS-TLIF手术治疗的单节段退行性腰椎病变患者52例(男28例,女24例,年龄54.3±7.8岁),记录手术时间,术中出血量,术后引流量,术后卧床时间,术前1d及术后1、3、5d血清肌酸激酶(CK)水平,并与同期行传统开放PLIF手术的38例患者(男20例,女18例,年龄51.6±8.6岁)进行比较。所有患者均于术前、术后及随访时进行腰背痛视觉模拟评分(VAS)、Oswestry功能障碍评分(ODI)和影像学检查。结果两组患者性别、年龄、临床诊断、病变节段、术前CK水平、术前腰背痛VAS评分和ODI评分差异均无统计学意义(P>0.05)。MIS-TLIF组手术时间长于PLIF组(P<0.05),术中出血量、术后引流量、术后卧床时间及术后1、3、5d血清CK水平均明显低于PLIF组(P<0.01),术后3d、5d、3个月时腰背痛VAS评分低于PLIF组(P<0.05),而术后6、12个月时VAS评分与PLIF组比较差异无统计学意义(P>0.05)。两组术后不同时间(3、6、12个月)ODI评分差异均无统计学意义(P>0.05)。术后影像学随访显示所有患者手术节段均在术后半年内获得良好的节段融合。结论与传统开放PLIF术式相比,MIS-TLIF治疗退行性腰椎疾病具有出血少、肌肉损伤少、腰背疼痛轻等优点。Objective To compare the postoperative muscle damage after either posterior lumbar interbody fusion （PLIF） or minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） with the aid of X-Tube system in patients with singlelevel degenerative lumbar spinal disease. Methods The clinical data of 52 patients （males 28, females 24, aged 54.3±7.8 years） with single-level degenerative lumbar spinal disease undergoing MIS-TLIF assisted by the X-Tube system from Oct 2010 to Sep 2011 was analyzed retrospectively. The operative time, intraoperative blood loss, postoperative drainage volume, postoperative bedtime, and serum creatine kinase （CK） level 1 day before surgery and 1, 3 and 5 days after surgery were recorded and compared with those of 38 patients （males 20, females 18, aged 51.6 ± 8.6 years） with the same disease undergoing conventional open PLIF during the corresponding period. The back pain visual analogue score （VAS）, Oswestry disability index （ODI） score and imaging examination were performed before operation, after operation and during follow-up duration for each patient. Results There was no significant difference in the gender, age, clinical diagnosis, lesion location, preoperative CK level, VAS and ODI scores between the two groups （P〉0.05）. The operative time was longer in MIS-TLIF group than in PLIF group （P〈0.05）, and the intraoperative blood loss, postoperative drainage volume, postoperative bedtime, and serum CK level 1, 3 and S days after surgery were lower in MIS-TLIF group than in PLIF group （P〈0.01）. The back pain VAS scores on 3rd day, 5th day and 3rd month after surgery in MIS-TLIF group were lower in PLIF group （P〈0.05）, and there was no significant difference in the score between two groups at 6th and 12th month. The ODI scores of two groups at different time periods after operation （3, 6 and 12 months） were similar （P〉0.05）. Radiological followup observation revealed good fusion 6 months after operation in all the patient

关 键 词：脊柱疾病 腰椎 脊柱融合术 外科手术 微创性 

分 类 号：R681.533[医药卫生—骨科学]