经多裂肌间隙入路腰椎间融合术治疗腰椎退行性疾病67例分析  

A clinical study of minimally invasive surgery transforminal lumbar intgerbody fusion through multifidus muscular approach

作　　者：杨大志[1] 王尔天[1] 王敏[1] 易伟宏[1] 余进[2] 

机构地区：[1]广东医学院附属南山医院脊柱外科,深圳518052 [2]鄂东医疗集团黄石市妇幼保健院脊柱外科

出　　处：《临床外科杂志》2016年第8期621-624,共4页Journal of Clinical Surgery

基　　金：广东省自然科学基金资助项目(S2012010008531;2015A030313877);深圳市科技创新委资助项目(CXZZ20130516151903472;JCYJ20140411094549460)

摘　　要：目的 探讨经多裂肌间隙入路行经椎间孔腰椎间融合术治疗腰椎退行性疾病的疗效.方法 单节段腰椎退行疾病患者67例,经多裂肌间隙入路行腰椎椎弓根螺钉内固定椎间融合器植骨融合术,137例经正中入路行腰椎椎弓根螺钉内固定椎间融合器植骨融合术,比较两组术前、术后疼痛视觉模拟量表（visual analog scale,VAS）评分、ODI（oswestry disability index）评分、手术时间、术中出血量、术后引流量和术后卧床时间.结果 两组患者随访9～ 36个月,平均14.3个月.多裂肌间隙入路组和经正中入路组术中出血量分别为（45.55±12.55） ml和（60.42±16.22）ml,术后引流量分别为（20.35±10.25）ml和（35.24±15.42） ml,术后3天VAS评分分别为（2.32±0.22）分和（3.84±0.32）分,术后卧床时间分别为（2.52±0.54）天和（5.22±2.24）天,术后3个月ODI评分分别为（26.54±4.32）分和（34.04±5.42）分,两组比较差异均有统计学意义（P＜0.05）.两组患者术前VAS和ODI评分、手术时间、术后3个月VAS评分、末次随访VAS和ODI评分比较差异均无统计学意义（P＞0.05）.结论 经多裂肌间隙入路治疗腰椎退行性疾病,手术创伤小、术后腰痛症状改善明显.Objective To investigate the clinical advantages and disadvantages transmutifidus approach in transforaminal lumbar interbody fusion （TLIF）surgery for patients with lumbar degenerative disease. Methods A total of 204 patients with single-level lumbar disc disease received TLIF and they were randomly assigned into 2 groups, including transmutifidus approach group （67 cases） and posterior midline surgical approach group （137cases）. The operative duration, intraoperative blood loss, postopera- tive drainage volume, postoperative time in bed, preoperative and postoperative visual analog scale （VAS） , and preoperative and postoperative Oswestry Disability Index （ODI） were compared separately by statistical analysis. Results All cases were followed up for 9 ~ 36 months, with an average of 14. 3 months. There were significant differences in intraoperative blood loss [ （ 45. 55 ± 12. 55 ） ml vs （ 60.42 ± 16.22 ） ml ], postoperative drainage volume [ （ 20.35 ± 10.25 ） ml vs （ 35.24 ± 15.42 ） ml ], postoperative 3-day VAS score [ （2.32 ± 0.22） vs and （ 3.84 ± 0.32） ], postoperative bed time [ （ 2.52 ± 0.54） d vs （0.54 ± 2.24） d] ,and postoperative 3-month ODI score [ （ 26.54 ± 4.32） vs （ 34.04 ± 5.42 ） ] between the transmutifidus approach group and posterior midline surgical approach group （ P 〈 0.05 ）. There were no significant differences in other parameters between the groups （ P 〉 0.05 ）. Conclu- sion In the TLIF surgery for patients with lumbar degenerative disease, the transmutifidus approach has advantages of few muscle damage and rapid postoperative recovery.

关 键 词：腰椎 退行性疾病 多裂肌 椎间融合 

分 类 号：R687.3[医药卫生—骨科学]