前路椎间融合术治疗腰椎退变性疾病的疗效比较  

Minimally invasive treatment of lumbar degenerative diseases by anterior lumbar interbody fusion

作　　者：张卫红[1] 张敏[1] 唐恒涛[1] 吴学建[1] 

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华实验外科杂志》2015年第5期1204-1207,共4页Chinese Journal of Experimental Surgery

摘　　要：目的 比较分析腰椎前路融合术治疗腰椎退变性疾病的临床疗效.方法 2010年4月至2012年8月单节段腰椎滑脱患者共76例,男21例,女14例,年龄27 ～ 72岁,平均年龄52岁.患者随机分为两组各38例分别行小切口前路椎间融合术（ALIF）以及传统腰椎后路椎间融合术（PLIF）.记录手术时间、手术并发症、卧床天数、住院天数、术中及术后出血量及术中、术后并发症,术后定期复查评价植骨融合情况.并用术后3个月MRI检查手术节段冠状面影像多裂肌,应用平手术节段直径2 cm圆形面积内T2弛豫时间,评价融合节段多裂肌损伤情况.术后末次随访临床结果评定采用末次随访手术前后Oswestry功能障碍评分（ODI）、疼痛视觉模拟评分（VAS）.按改良MacNab分级进行评定.结果 76例患者均顺利完成手术,其中ALIF组38例,手术切口长度4～10 cm[（6.5 ±2.1）cm],平均术中出血量50 ～ 150 ml[（90.8 ±28.1） ml],手术时间65 ～ 130 min[（75.2±11.5） min],术后卧床1～4 d[（2.1±0.3）d],住院时间4～10d[（5.1±1.8）d].术中腹膜撕裂5例,术中即时予以缝合修补;术中腰升静脉撕裂1例,术中立即银夹止血;术后腹胀6例,术后2～3d缓解.术后半个月ROI-A融合器脱位1例,给予外固定3个月,直至骨性融合.术后未发现下肢深静脉血栓、逆向射精等并发症.76例患者均获得随访,随访时间12～ 26个月,平均6.3个月,术后腰腿痛症状明显缓解.末次随访时腰椎X线及CT示所有患者均获骨性融合,5例获可疑融合,融合率为93.4％.末次随访时疼痛的VAS评分、ODI评分较术前明显改善,差异均有统计学意义,改良MacNab分级评定优良率ALIF组为92.1％,传统PLIF组为94.7％.术后3个月ALIF组12例患者接受腰椎MRI手术节段扫描,两组间差异有统计学意义（P＜0.05）.结论 经腹直肌旁小切口腹膜外间隙入路联合自锁型椎间融合器治疗腰椎退变性疾病具有创伤小、术后恢复快Objective To explore the clinical efficacy of minimally invasive treatment of lumbar degenerative diseases by anterior lumbar interbody fusion （ALIF）.Methods From April 2010 to August 2012,76 patients with single-level lumbar degenerative diseases were divided into two groups randomly,given ALIF and tranditional posterior lumbar interverbody fusion （PLIF） respectively.The skin incision length,operative time,blood loss and complication were observed.Posterior radiological evaluation was done by MRI image with Taillard index and T2 relaxation time of the operative level on the post-operative month 3.The visual analogue scores （VAS）,Oswestry disablility index （ODI） scores and MacNab grade were used for clinical assessment.Results All patients were operated successfully and got alleviation of the symptoms to varying degrees.The average skin incision length,the average operative time,the average blood loss and hospital stays were significantly reduced in ALIF group as compared with PLIF group.All cases were followed up for 18-50 months （average 26.4 months）.The complication occurred in 5 cases.At the final followed-up,the radiography showed that 71 cases got bone fusion,and 5 cases got suspicious fusion with the fusion rate being 93.4%.There was significant difference in the average VAS scores and ODI scores between ALIF group and PLIF group in the one-month follow-up.However,at the final follow-up there was no significant difference.Conclusion Minimally invasive treatment of lumbar degenerative diseases by ALIF has the advantages of less invasion,less blood loss,quicker recovery,and less complications.The clinical effect was satisfactory.

关 键 词：腰椎退变性疾病 前路椎间融合术 微创 

分 类 号：R687.3[医药卫生—骨科学]