微创经椎间孔腰椎间融合术治疗高位腰椎间盘突出症  

TREATMENT OF UPPER LUMBAR DISC HERNIATION BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

作　　者：郑勇[1] 王建[1] 袁超[1] 郑文杰[1] 李长青[1] 张正丰[1] 周跃[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037

出　　处：《中国修复重建外科杂志》2014年第4期480-484,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨微创经椎间孔腰椎间融合术（minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF）治疗高位腰椎间盘突出症的安全性和有效性。方法 回顾分析2007年12月-2012年5月收治的符合选择标准的26例高位腰椎间盘突出症患者临床资料,根据治疗方法不同分为MIS-TLIF组（14例）和传统的开放经椎间孔腰椎间融合术（open transforaminal lumbar interbody fusion,OTLIF）组（12例）。两组患者性别、年龄、病程、病变节段、侧别等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。分析两组手术时间、术中出血量、术后引流量、并发症等方面差异;采用腰、腿疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评分评估临床效果,行腰椎动力位X线片和CT三维重建检查评价椎间融合情况。结果 术后两组患者切口均Ⅰ期愈合。两组手术时间比较差异无统计学意义（t=0.858,P=0.399）;但MIS-TLIF组术中出血量及术后引流量均明显少于OTLIF组（P〈0.05）。26例均获随访,随访时间12～50个月,平均34.1个月。无硬脊膜撕裂、感染、脊髓神经损伤、内植物失效等手术相关并发症发生。两组术前腰、腿痛VAS评分及ODI评分比较差异均无统计学意义（P〉0.05）。MIS-TILF组术后1 d腰痛VAS评分及ODI评分均显著低于OTLIF组（P〈0.05）,腿痛VAS评分两组比较差异无统计学意义（P〉0.05）;末次随访时两组各评分比较差异均无统计学意义（P〉0.05）。末次随访时MIS-TLIF组和OTLIF组椎间融合率分别为92.8%（13/14）和100%（12/12）。结论 MIS-TLIF治疗高位腰椎间盘突出症安全、有效,是一种可选择技术。Objective To investigate the effectiveness and safety of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） for upper lumbar disc herniation. Methods Retrospective analysis was made on the clinical data of 26 patients with upper lumbar disc herniation, who were in line with the selection criteria and underwent MIS-TLIF in 14 patients （MIS-TLIF group） and open transforaminal lumbar interbody fusion （OTLIF） in 12 patients （OTLIF group） between December 2007 and May 2012. There was no significant difference in gender, age, disease duration, level of disc herniation, side of disc herniation between 2 groups （P 〉 0.05）. The operation time, intraoperative blood loss, postoperative drainage volume, and complications were compared between 2 groups. The clinical outcome was assessed using the visual analogue scale （VAS） and the Oswestry disability index （ODI） scores. The fusion rate was determined by using CT three-dimensional reconstruction and dynamic lumbar radiography at last follow-up. Results Primary healing of incisions was obtained in both groups. No difference was found in operation time between 2 groups （t=0.858, P--0.399）, but MIS-TLIF group had less intraoperative blood loss and postoperative drainage volume than OTLIF group （P 〈 0.05）. The average follow-up duration was 34.1 months with a range of 12-50 months. No complication of dural tear, infection, spinal nerve trauma, and implant failure occurred. The VAS scores of lower back pain and radicular pain and ODI scores at preoperation showed no significant difference between 2 groups （P 〉 0.05）. The VAS score of lower back pain and ODI score at 1 day after operation in MIS-TLIF group were significantly lower than those in the OTLIF group （P 〈 0.05）, but no difference was found in VAS scores of radicular pain between 2 groups （P 〉 0.05）. Difference in all scores was not significant at last follow-up between 2 groups （P 〉 0.05）. The fusion rate was 92.8% （13/14） in MIS-TLIF gr

关 键 词：高位腰椎间盘突出症 微创外科 经椎间孔腰椎融合术 

分 类 号：R687.3[医药卫生—骨科学]