微创与开放经椎间孔椎间融合术治疗单间隙腰椎退行性疾病及中长期临床疗效比较  

Comparison of the mid-and long-term clinical outcomes of Minimally invasive versus open Transforaminal Lumbar Interbody Fusion in treatment of one-level lumbar degenerative disease

作　　者：俞伟杨[1,2] 何登伟[1,2] 刘飞俊[1,2] 

机构地区：[1]温州医科大学附属第五医院 [2]丽水市中心医院,丽水323000

出　　处：《浙江创伤外科》2015年第2期201-205,共5页Zhejiang Journal of Traumatic Surgery

基　　金：浙江省丽水市科技公益性技术应用项目(2012JYZB92)

摘　　要：目的：比较微创（Minimally invasive，MIS）与常规开放椎弓根螺钉联合经椎间孔椎间融合术（TLIF）治疗单间隙腰椎退行性疾病的中长期疗效。方法回顾性分析单间隙腰椎退行性疾病患者92例，其中微创组47例，开放组45例，微创组均采用可扩张通道（Quadrant）和经皮椎弓根螺钉（Sextant）技术。比较两种手术方式的手术时间、术中出血量、透视次数、术后下床活动时间、住院时间以及相关并发症。采用视觉模拟评分（VAS）评估患者术前、末次随访时疼痛情况，Oswestry功能障碍指数评分（ODI）评价疗效，通过影像学测量不同部位椎间隙高度，并评估末次随访时椎体间融合情况及远期并发症。结果所有患者随访4～7年，平均5.3年。术中出血量、术后下床活动时间和住院时间微创组较开放组明显减少（P〈0.05），手术时间及透视次数微创组较开放组延长（P〈0.05）。两组患者术后VAS及ODI评分均较术前有明显改善（P〈0.05），两组间术前及末次随访时VAS及ODI评分的差异无统计学意义（P〉0.05）。微创组与开放组在手术前后不同部位椎间隙高度差异无统计学意义（P〉0.05），但末次随访时椎间隙高度均较术前改善，且差异具有统计学意义（P〈0.05）。融合率微创组与开放组无显著差异（P〉0.05）。影像学检查结果显示相邻节段退变发生率微创组较开放组降低（P〈0.05）。随访期间两组均未发现继发性脊柱侧弯，Cage移位及螺钉松动、断裂等并发症发生。结论与开放手术相比较，微创组具有减少术中出血量，缩短下床活动时间和住院时间，降低相邻节段退变发生率的优点，但需要较长的手术时间及术者接受较多的放射线暴露。微创与常规开放椎弓根螺钉联合经椎间孔椎间融合术治疗腰椎退行性疾病均能获得满意的长期疗效。Objective To investigate the mid-and long-term clinical outcomes of minimally invasive （MIS） versus open transforaminal lumbar in-terbody fusion （TLIF） in treatment of one-level lumbar degenerative disease. Methods 92 patients with one-level lumbar degenerative disease underwent surgical intervention were retrospectively analyzed, 47patients in MIS-TLIF group and 45 patients in open-TLIF group. MIS-TLIF was done by using ex-pandable working tubes （Quadrant） and percutaneous pedicle screws （Sextant）. Operative time, intra-operative bleeding, radiation exposure time, time to re-sume early activity, hospital time and general complications were recorded. Postsurgical pain and functional results were analyzed by the visual analog scale （VAS） and Oswestry Disability Index （ODI）. Radiological examination was obtained to assess the height of intervertebral space, postoperative intervertebral fusion conditions and long term complications. Results The mean follow-up was 5.3 years, with a range of 4 to 7 years. The group of MIS-TLIF was su-perior to the group of open-TLIF in intra-operative bleeding, time to resume early activity, hospital time （ P〈0.05）. The group of MIS-TLIF need more opera-tion time and were exposed to more X-ray compared to the open-TLIF group （ P〈0.05）. The most frequently used methods to assess the clinical function were visual analog VAS scores and ODI scores. The ODI and VAS scores post-operation improved significantly in each group （ P〈0.05）, but showed no significant difference between the 2 groups at pre-operation and last follow-up （ P〉0.05）. No statistical difference of each patient to assess the height of intervertebral space between preoperation and final follow-up for each group was noted （ P〉0.05）, but the postoperative radiologic indexes of all patients were higher than the preoperative ones （P〈0.05）.The fusion rate was no significant difference between the two groups （ P〉0.05）. The MIS-TLIF group was associated with signifi

关 键 词：退行性腰椎疾病 外科手术 微创性 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]