可扩张通道下MIS-TLIF手术治疗单节段退变性腰椎管狭窄症疗效评价  

Clinical effect of minimally invasive surgery transforaminal lumbar interbody fusion in the treatment of single-level degenerative lumbar spinal stenosis

作　　者：王晓陆[1] 刘艺明[1] 张之栋[1] 杜怡斌[1] 李春[1] 马力[1] 郑科[1] 郁贤舜[1] WANG Xiao-lu LIU Yi-ming ZHANG Zhi-dong et al(Department of Spinal Surgery, The First People＇s Hospital of Hefei, Hefei, Anhui 230031, China)

机构地区：[1]合肥市第一人民医院脊柱外科,安徽合肥230031

出　　处：《颈腰痛杂志》2017年第4期339-343,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨经后路可扩张通道管下微创经椎间孔入路腰椎椎体间融合术治疗单节段退变性腰椎管狭窄症(lumbar spinal stenosis,LSS)的临床疗效。方法前瞻性研究自2014-01-2016-01 40例退变性单节段腰椎管狭窄症患者随机分成MIS-TLIF(A组)和PLIF(B组)两组,每组20例。A组经MIS-TLIF技术行狭窄节段减压椎间盘摘除椎间植骨融合后路内固定,B组经传统后路开放减压椎体间植骨融合内固定手术,记手术时间、术中出血量、术后引流量、术后24h切口疼痛VAS评分,6个月及1年随访经ODI评分、下腰痛VAS评分、改良Macnab疗效评定标准评价疗效等,并经统计学分析。结果 A、B两组术中出血量、术后引流量及术后24h切口疼痛VAS评分统计学有差异(P<0.01),A组优于B组;术后半年及1年在ODI评分及下腰痛VAS评分两组差别无统计学意义(P>0.05);随访1年经改良Macnab疗效评定标准评价结果 2组优良率均为95%;术后1年2组均达骨性融合。结论 MIS-TLIF治疗单节段退行性腰椎管狭窄症,可获得与开放PLIF手术相同的早中期临床疗效及植骨融合率,并且术中出血量、术后引流量较少,术后早期切口疼痛较轻,术后并发症少等具有较高的安全性。Objective To evaluate the clinical effect of minimally invasive surgery transforaminal lumbar interbody fusion in the treatment of single-level degenerative lumbar spinal stenosis. Methods From January 2014 to January 2016, a total of 40 cases with single-level lumbar spinal stenosis who underwent surgical intervention were prospectively analyzed. Among them, 20 cases in group A received minimally invasive surgery transforaminal lumbar interbody fusion, and 20 cases in group B received open surgery of posterior lumbar interbody fusion. Operation time, intraoperation and post-operation bleeding were recorded. Incision pain was assessed by visual analogue scale （VAS） at 24 h of post-operation, and VAS and lumbar function were evaluated by Oswestry Disability Index （OD[） during postoperative follow-up, then the results were statistically analyzed. Results There were no significant differences in age, sex, surgery segment between group A and group B （P 〉 0.05）. The mean follow-up time was 12 months in group A and group B, no significant difference was detected （P 〉 0.05）. There was no significant difference between group A and group B in satisfactory clinical outcome and osseous fusion in the terms of operation time, ODI and the VAS score of low back pain at the final follow-up （P 〉 0.05）. However, intraoperative and post-operative bleeding, the VAS of 24 h after operation of incision pain in group A were less or lower, and in group B were more or higher （P〈O.OI）. There were significant improvements of ODI and VAS of low back pain in two groups between preoperation and postoperation （P〈O.0I）. The excellent and good rate of the standard of Macnab in both two groups was 95%. Conclusion MIS-TI,IF as well as PLIF can get safisfaclory early-medium-term clinical outcome. MIS-TLIF has advantages as follows： less intraopcrative and post-operative bleeding, lower incidence of incision pain of the early posIoperation. MIS-TLIF is a safe and reliable operation for Ireatment of LSS.

关 键 词：MIS—TLIF技术 退变性腰椎管狭窄症 单节段 临床疗效 

分 类 号：R681.55[医药卫生—骨科学]