微创经椎间孔腰椎椎间融合治疗腰椎退变性疾病的中远期疗效分析  

Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease at more than 5 years follow-up： a review of 832 patients

作　　者：刘超[1] 王建[1] 张正丰[1] 李长青[1] 郑文杰[1] 张超[1] 潘勇[1] 周跃[1] Liu Chao;Wang Jian;Zhang Zhen~eng;Li Changqing;Zheng Wenjie;Zhang Chao;Pan Yong;Zhou Yue(Department of Orthopaedic Surgery,Affiliated Xinqiao Hospital,The Third Military Medical University,Chongqing 400037,China)

机构地区：[1]第三军医大学附属新桥医院骨科,重庆400037

出　　处：《中华骨科杂志》2018年第20期1266-1272,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨微创经椎问孔腰椎椎间融合术（minimally invasive surgery-transforaminal lumbar interbody fusion，MIS-TLIF）治疗单节段腰椎退变性疾病的中远期临床疗效。方法回顾性分析2007年至2013年采用单节段MIS-TLIF手术治疗832例腰椎退变性疾病患者的病历资料，男443例，女389例；年龄23-82岁，平均（56．4±18．7）岁。分为翻修手术组、重度腰椎管狭窄症组、中重度腰椎滑脱症组及一般病例组（作为对照）进行对比分析。疗效评价指标包括Oswestry功能障碍指数（Oswestry disability index，ODI）、疼痛视觉模拟评分（visualanalogue scale，VAS）、椎间融合率及并发症发生情况。结果所者患者均得到随访，随访时间62~93个月，平均（79．2±18．6）个月。术后1个月，重度椎管狭窄症组及中重度滑脱症组腰痛VAS评分分别为（2．9±0．5）分及（3．8±1．1）分，较一般病例组（1．6±0．6）分高，差异均有统计学意义；中重度滑脱组下肢痛VAS评分为（2．6±0．7）分相较其他三组高，但差异无统计学意义；中重度滑脱组ODI为28．8％±6．9％较一般病例组22．1％±6．4％高，差异有统计学意义。术后2年，中重度滑脱症组腰痛VAS评分为（2．4±0．9）分，较一般病例组（1．7±0．5）分高，差异有统计学意义；重度椎管狭窄症组及中重度滑脱症组ODI分别为17．9％±3．4％及19．4％±4．9％较一般病例组1113％±3．3％高，差异有统计学意义。末次随访，重度椎管狭窄症组及中重度滑脱症组腰痛VAS评分分别为（2．3±0．8）分及（2．6±1．1）分，较一般病例组（1．6±0．7）分高，差异均有统计学意义；重度椎管狭窄症组及中重度滑脱症组ODI分别为18．3％±11．1％及19．6％±12．1％较一般病例组11．8％±9．7％高，差异有统计学意义。翻修手术组、重度腰椎管狭窄组以及中重度腰椎滑脱症组硬膜撕裂风�Objective To observe the mid-and long-term clinical efficacy of minimally invasive transforaminal lumbar interbody fusion for the treatment of single-segment lumbar degenerative diseases. Methods Retrospective analysis of the clin-ical data of 832 patients with lumbar degenerative disease treated with single-segment MIS-TLIF surgery from 2007 to 2013, 443 males and 389 females; aged 23-82 years, mean 56.4±18.7 years old. All cases were divided into revision surgery group, severe lumbar spinal stenosis group, moderate to severe lumbar spondylolisthesis group and general case groups （as a control） for comparative analysis. Efficacy evaluation indicators include Oswestry disability index （ODI）, visual analog scale （VAS）, in-tervertebral fusion rate, and complications. Results All patients were followed up for 62 to 93 months, with an average of 79.2±18.6 months. One month after operation, the VAS score of low back pain in the severe spinal stenosis group 2.9±0.5 and the moderate to severe spondylolisthesis group 3.8±1.1 were both significantly higher than the general case group 1.6±0.6, and the difference was statistically significant. The VAS score of leg pain was high in the moderate to severe slip group 2.6±0.7, but the difference was not statistically significant. The ODI value was significantly higher in the moderate to severe spoiler group 28.8±6.9% than in the general case group 22.1±6.4%. In the 2 years after the operation, the vas of lower back pain was divided into 2.4±0.9, compared with the general case group 1.7±0.5, and the difference was statistically significant; the ODI group of severe spinal stenosis and moderate-severe spondylolisthesis were 17.9%±3.4% and 19.4%±4.9%, respectively,which was higher than the general case group 11.3%±3.3%, and the difference was statistically signifieant. In the last folh）w-up, the VAS scores 2.3±0.8 and 2.6±1.1 of the severe vertebral canal stenosis group and the moderate-severe spondylolisthesis group were respectively higher than that o

关 键 词：腰椎 外科手术 微创性 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]