微创与开放后路腰椎间融合修复单节段腰椎退变性疾病：椎间融合率比较  

Minimally invasive versus open posterior lumbar interbody fusion for single-segment degenerative lumbar disease: the rate of interbody fusion

作　　者：过锡敏 

机构地区：[1]无锡市惠山区人民医院骨科,江苏省无锡市214187

出　　处：《中国组织工程研究》2015年第39期6321-6326,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着人口老年化,腰椎退变性疾病发病率显著增高,但是目前其最佳治疗方式仍存在争议。目的:比较微创后路腰椎间融合与开放后路腰间椎融合修复单节段腰椎退变性疾病的临床效果和影像学结果。方法:回顾分析2006年7月至2012年7月无锡市惠山区人民医院收治的97例单节段腰椎退变性疾病患者的临床资料,根据修复方式分为两组,微创组(n=51)采用微创后路腰椎间融合治疗,开放组(n=46)采用开放后路腰椎间融合治疗。比较两组患者的手术时间、失血量(术中失血量+术后引流量)、总输血量、治疗后腰痛程度(采用目测类比评分评估)、住院时间、卧床时间、围手术期并发症、临床功能(采用Oswestry功能障碍指数评估)及治疗后影像学结果。结果与结论:97例患者均获随访,微创组随访28-78个月,开放组随访27-76个月,两组差异无显著性意义(P=0.981)。微创组手术时间、失血量、输血量、卧床时间、住院时间及末次随访时腰痛目测类比评分均显著低于开放组(P<0.05);但两组患者末次随访时的ODI、螺钉位置不良率、Cage移位率、椎间隙高度丢失值及椎间融合率差异均无显著性意义(P>0.05)。提示对于单节段腰椎退变性疾病,微创与开放后路腰椎间融合治疗均可获得满意的修复效果,但是微创后路腰椎融合具有创伤小、卧床及住院时间短、残留腰疼轻等优点。BACKGROUND： With the aging population, the incidence of lumbar degenerative disease was apparently increased, but how to treatment of degenerative lumbar disease remains controversial. OBJECTIVE： To compare clinical and radiographic results of minimally invasive posterior lumbar interbody fusion and open posterior lumbar interbody fusion for single-segment degenerative lumbar disease. METHODS： We retrospectively analyzed the clinical data of 97 patients with single-segment degenerative lumbar disease, who were treated in the Huishan District People＇s Hospital of Wuxi City from July 2006 to July 2012. These patients were divided into minimal group（minimally invasive posterior lumbar interbody fusion; n=51） and open group（open posterior lumbar interbody fusion; n=46）. These data were compared between the two groups, including operative time, blood loss（intraoperative blood volume＋postoperative drainage volume）, total blood transfusion, postoperative back pain（visual analogue scale）, length of hospital stay, bed time, perioperative complications, clinical function（Oswestry disability index）, and radiographic results. RESULTS AND CONCLUSION： All of 97 patients were followed up. The duration of follow-up was 28-78 months and 27-76 months in minimal group and open group, respectively. There was no significant difference between the minimal group and open group in term of followed-up time（P=0.981）. Operative time, blood loss, total blood transfusion, bed time, length of hospital stay and visual analogue scale score during final follow-up were significantly lower in the minimal group than in the open group（P〉 0.05）. However, there was no significant difference between the two groups in Oswestry disability index during final follow-up, the rate of screw malposition, the rate of Cage shift, loss value of intervertebral height and the rate of interbody fusion（P 0.05）. These results indicate that for the single-segment degenerative lumbar disease, the use of minimally invasive po

关 键 词：腰椎 外科手术 脊柱融合术 外科手术 微创性 内固定器 骨科植入物 脊柱植入物 腰椎退变性疾病 微创手术 开放手术 后路腰椎间融合 内固定 

分 类 号：R318[医药卫生—生物医学工程]