微创脊柱内镜系统辅助下改良椎间孔腰椎椎间融合术治疗腰椎间盘损伤  

Modified transforaminal lumbar interbody fusion for acute and chronic lumbar intervertebral disc injury via minimally invasive expandable access system

作　　者：王长昇[1] 林建华[1] 许卫红[1] 陈荣生[1] 吴荔军[1] 

机构地区：[1]福建医科大学附属第一医院脊柱外科,福州350005

出　　处：《中华创伤杂志》2015年第10期868-872,共5页Chinese Journal of Trauma

基　　金：福建省科技厅社会发展重点资助项目（2013Y0038）

摘　　要：目的探讨微创脊柱内镜系统辅助下行改良经椎间孔腰椎椎间融合术（TLIF）治疗急、慢性腰椎间盘损伤性腰椎疾病的临床疗效。方法选择2013年3月-2014年11月收治的腰椎间盘损伤患者45例，累及部位：L3/4间隙5例，L4/5间隙28例，L5～S1间隙12例。根据治疗方法分为两组：微创改良TLIF组（A组）22例，其中男12例，女10例；年龄（53．70±3．59）岁（43-67岁）和开放改良TLIF组（B组）23例，其中男14例，女9例；年龄（54．80±4．37）岁（42-68岁）。比较两组手术时间、术中出血量、术后引流量、术后下地时间及手术并发症，观察两组患者手术前后视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）及椎间植骨融合情况。结果术中出血量、术后引流量、下地时间及术后1周VAS评分A组分别为（152．1±15．5）ml，（106．1±14．3）ml，（4．5±1．1）d及（3．0±0．7）分，均优于B组的（409．9±28．3）ml，（223．0±19．4）ml，（8．9±1．4）d及（4．7±0．4）分（P〈0．05）。两组末次随访时VAS及ODI评分均较术前明显改善（P〈0．05），但两组手术时间及末次随访时VAS和ODI评分差异无统计学意义（P〉0．05）。术后6个月植骨融合率A组为95％（21／22），B组为96％（22／23）（P〉0．05）。两组患者均无神经根损伤、椎间隙感染等并发症。结论微创通道镜系统辅助下行改良TLIF治疗急、慢性腰椎间盘损伤的创伤小、出血少、早期恢复快，远期可获得与传统开放手术同样满意的临床疗效。Objective To evaluate outcomes of modified transforaminal lumbar interbody fusion （TLIF） assisted by the minimally invasive expandable access system and spinal channel endoscope for acute and chronic lumbar intervertebral disc injury. Methods From March 2013 to November 2014, 45 patients with lumbar intervertebral disc injury were managed with minimally invasive （Group A） or open TLIF （ Group B）. Location for disc injury was at L9/4 in 5 patients, L4/5 in 28 patients and Ls-SZ in 12 patients. Group A composing 12 males and 10 females showed age of （53.70 ±3.59） years （range, 43 to 67 years）. Group B composing 14 males and 9 females showed age of （54. 80 ± 4. 37）years （range, 42 to 68 years）. Between-group comparison was conducted with respect to operation time, blood loss, postoperative drainage loss, ambulation time and postoperative complications. Clinical outcomes were evaluated using the visual analogue scale （VAS） , Oswestry dysfunction index （ODI） , and bone fusion rate. Results Except for the comparable operation time, group A was associated with better results in the blood loss [ （ 152.1 ± 15.5 ） ml vs （ 409.9 ± 28.3 ） ml ], drainage volume [ （ 106. 1 ± 14.3）ml vs （223.0± 19.4）ml], ambulation time[（4.5±1. 1）d vs （8.9 ±1.4）d] and 1-week postoperative VAS [ （ 3.0 ± 0.7 ） points vs （ 4.7 ± 0.4 ） points ] （ P 〈 0.05 ）. At the final follow-up, VAS and ODI of both groups were significantly improved compared to the preoperative levels （ P 〈 0.05 ） , but the differences between groups were insignificant （P 〉 0.05 ）. Bone fusion rate in Group A was 95%（21/22） versus 96% （22/23） in Group B 6-month postoperatively （P 〉0.05）. No nerve root injury, intervertebral space infection or other complications occurred. Conclusion Modified TLIF assisted by the minimally invasive expandable access system offers the benefits of less trauma, less bleeding and a quicker recovery for acute and chronic lumbar intervertebral

关 键 词：椎间盘 腰椎 内窥镜 经椎间孔腰椎椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]