微创经椎间孔腰椎间融合术联合中药封包疗法治疗腰椎滑脱症的临床研究  

Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with traditional Chinese medicine packet therapy for treatment of lumbar spondylolisthesis

作　　者：杨子情 豆贲[1] 谢义松[1] 徐无忌[1] 孙国荣[1] 吴小辉[1] 袁万福 刘晓岚[1] 

机构地区：[1]湖南中医药大学第二附属医院,湖南长沙410005

出　　处：《中医正骨》2016年第7期28-37,共10页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的：观察微创经椎间孔腰椎间融合术（transforaminal lumbar interbody fusion,TLIF）联合中药封包疗法治疗腰椎滑脱症的临床疗效和安全性。方法：回顾性分析116例手术治疗的腰椎滑脱症患者的病例资料。28例采用开放TLIF治疗（TLIF组）、31例采用开放TLIF联合中药封包治疗（TLIF联合组）、27例采用微创TLIF治疗（MIS-TLIF组）、30例采用微创TLIF联合中药封包治疗（MIS-TLIF联合组）。微创TLIF采用CN12M009 Quadrant系统进行手术,中药封包疗法所用药物为消炎散。比较各组的并发症发生情况、手术时间、术中出血量、术后引流量、住院时间、疼痛视觉模拟量表（visual analogue scale,VAS）评分、Oswestry功能障碍指数（Oswestry disability index,ODI）评分、外周静脉血肌酸激酶（creatine kinase,CK）含量及多裂肌横截面积和灰度值。多裂肌横截面积和灰度值采用Image J v2.1软件在腰椎T2WI MRI上进行测量。结果：所有患者均获得随访,随访时间12~24个月。术后TLIF组2例患者出现神经损伤表现,使用神经营养药物治疗后逐渐好转;各组均未发生椎间隙感染、脑脊液漏、下肢深静脉血栓、内固定材料断裂或松动、椎间隙高度丢失、椎体间Cage下陷及移位等并发症。至末次随访时,所有患者腰椎滑脱均已复位,融合椎体均已获得骨性愈合。TLIF组和TLIF联合组手术时间比较,MIS-TLIF组和MIS-TLIF联合组手术时间比较,组间差异均无统计学意义;TLIF组和TLIF联合组手术时间均比MIS-TLIF组和MIS-TLIF联合组长（P=0.000,P=0.000;P=0.000,P=0.000）。TLIF组和TLIF联合组术中出血量比较,MIS-TLIF组和MIS-TLIF联合组术中出血量比较,组间差异均无统计学意义;TLIF组和TLIF联合组术中出血量均比MIS-TLIF组和MIS-TLIF联合组多（P=0.000,P=0.000;P=0.000,P=0.000）。TLIF组和TLIF联合组术后引流量比较,MIS-TLIF组和MIS-TLIF联合组术后引流量比较,组间差异均无统Objective： To observe the clinical curative effects and safety of minimally invasive transforaminal lumbar interbody fusion（ TLIF） combined with traditional Chinese medicine（ TCM） packet therapy in the treatment of lumbar spondylolisthesis. Methods： The medical records of 116 patients with lumbar spondylolisthesis were analyzed retrospectively. Twenty- eight patients were treated with open TLIF（ TLIF group）,thirty- one patients were treated with open TLIF combined with TCM packet therapy（ TLIF combined- treatment group）,twenty- seven patients were treated with minimally invasive TLIF（ MIS- TLIF group）,while the others were treated with MIS-TLIF combined with TCM packet therapy（ MIS- TLIF combined- treatment group）. CN12M009 Quadrant system was used for MIS- TLIF surgery,and Xiaoyan San（ 消炎散） was used for TCM packet therapy. The complications,operative times,intraoperatve blood loss,postoperative drainage,hospital stay,pain visual analogue scale（ VAS） scores,Oswestry disability index（ ODI） scores,peripheral venous blood creatine kinase（ CK） contents and cross sectional areas（ CSA） and gray values of multifidus were compared between the 4 groups. The CSA and gray values of multifidus were measured by using Image J v2. 1 software on T2- weighted MRI of lumbar spine. Results： All patients in the4 groups were followed up for 12- 24 months. Nerve injuries were found in 2 patients in TLIF group after surgery,and the patients improved gradually after treatment with neurotrophic drugs. No complications such as intervertebral space infection,cerebrospinal fluid leakage,lower extremity deep venous thrombosis,breakage or loosening of internal fixators,loss of interspace height loss and sag and displacement of intervertebral cage were found in all of the groups. All patients obtained reduction of lumbar spondylolisthesis and bone union of fused vertebra at last follow- up. There was no statistical difference in operative time between TLIF group and TLIF combined- treatme

关 键 词：脊椎滑脱 腰椎 脊柱融合术 椎间孔 外科手术 微创性 热敷 临床试验 

分 类 号：R687.3[医药卫生—骨科学]