MIS-TLIF与PLIF治疗单节段退行性腰椎疾病的围手术期比较  

Comparison of perioperative characteristics between patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion and those undergoing posterior lumbar interbody fusion for the treatment of single level degenerative lumbar diseases

作　　者：周亮[1] 刘郑生[1] 肖嵩华[1] 毛克亚[1] 刘建恒[1] 史腾 苏祥正 

机构地区：[1]解放军总医院骨科,北京复兴路28号100853

出　　处：《中国矫形外科杂志》2014年第9期769-774,共6页Orthopedic Journal of China

基　　金：军队十二五课题(CWS11J110)微创治疗战创伤脊柱骨折~~

摘　　要：[目的]通过与传统开放性后路腰椎椎体问融合术（PLIF）比较，探讨X—Tube辅助微创经椎间孔入路腰椎椎体间融合术（MIS—TLIF）治疗单节段退行性腰椎疾患，在围手术期的优势。[方法]回顾性分析2010年10月～2011年9月，采用MIS—TLIF手术治疗的单节段退行性腰椎病变患者52例，记录手术时间、术中出血量、术中x线照射时间、术后引流量、卧床时间和住院时间，以及术前1d、术后1、3、5d静脉血WBC、CRP、ESR水平，并与同期行传统开放PLIF手术的38例患者进行比较。所有患者均进行定期随访，并根据ODI评分和影像学检查评估手术疗效。[结果]两组病例在性别、年龄、临床诊断、病变节段、术前WBC、CRP、ESR水平及ODI评分等方面差异均无统计学意义（P〉0．05）。微创组手术时间和术中x线透射时间长于开放组（P〈0．05）；术中出血量和术后引流量、卧床时间、住院时间均明显少于开放组（P〈0．01）。术后第1d，微创组CRP明显低于开放组（P〈0．01），WBC、ESR与开放组相比，无明显差异；术后第3d，微创组WBC、CRP、ESR均明显低于开放组（P〈0．01）；术后第5d，微创组WBC、CRP、ESR均低于开放组（P〈0．05）。两组病例各时间点ODI评分无明显差异（P〉0．05），所有患者术后随访影像学检查提示，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术式治疗单节段退行性腰椎疾患，具有术中出血少、创伤小、术后康复快等优势。[ Objective ] To evaluate the advantages of minimally invasive surgery - transforaminal lumbar interbody fusion （MIS -TLIF） , assisted by the X- Tube system, compared with those of the traditional open posterior lumbar interbody fusion （PLIF） for the management of degenerative lumbar diseases. [ Methods] From Oct 2010 to Sep 2011, 52 patients with single level degenerative lumbar diseases underwent MIS - TLIF, while 38 controls underwent traditional open PLIF. The data obtained from all the patients were analyzed retrospectively. The surgery time, intraoperative blood loss, X - ray exposure time, postoper- ative drainage volume, bed time, and hospital time were compared between the 2 groups. We also evaluated the white blood cell （WBC） counts, C -reactive protein （CRP） levels, and erythrocyte sedimentation rates （ESR） before surgery and 1, 3, and 5 days after surgery, respectively. Furthermore, clinical outcomes were measured in terms of Oswestry Disability Index （ODI） and X - ray examinations were performed before surgery, after surgery, and during follow - up. [ Results ] There were no significant differences in the gender, age, clinical diagnosis, lesion location, preoperative WBC counts, CRP levels, ESR, and ODI scores between the 2 groups （ P 〉 0. 05 ） . The patients in the MIS group had a longer surgery time and X - ray exposure time than those in the open group （ P 〈 0. 05 ） ; whereas, they had less intraoperative blood loss, less postoperative drainage volume, and less postoperative bed time and hospital time （P 〈 0. 01 ） . On the first day after surgery, CRP levels in the MIS group were significantly lower than in the open group （ P 〈 0. 01 ）, while WBC counts and ESR showed no significant differences between the 2 groups. On the third day after surgery, WBC counts, CRP levels, and ESR in the MIS group were lower than in the opengroup （ P 〈 0. 05 ） . On the fifth day after surgery, the WBC counts, CRP levels, and ESR levels in the MIS group were signi

关 键 词：脊柱疾病 腰椎 外科手术 微创性 围手术期 

分 类 号：R687.3[医药卫生—骨科学]