微创经椎间孔入路椎体间融合术治疗腰椎滑脱症的近期疗效和安全性分析  

Early Clinical Effect and Safety of Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis

作　　者：白亮[1] 庄全魁[1] Bai Liang;Zhuang Quankui(Department of Orthopedics,2nd People's Hospital of Fuyang,Fuyang 236015,China)

机构地区：[1]阜阳市第二人民医院骨科,安徽阜阳236015

出　　处：《实用骨科杂志》2018年第3期197-200,共4页Journal of Practical Orthopaedics

摘　　要：目的分析微创经椎间孔入路椎体间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎滑脱症的近期疗效和安全性。方法选取2015年1月至2017年6月间我院收治的60例腰椎滑脱症患者作为研究对象,随机分为观察组和对照组;其中30例采用MIS-TLIF手术干预作为观察组,而另外30例采用传统后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF),设为对照组,术后随访至少3个月。比较两组患者手术时间、术中输血量以及术后引流量之间差异;于术前、术后3个月采用腰椎正侧位X线片、CT或MRI检查,计算两组患者手术前后腰椎滑脱角变化;分别于术后3d、1个月、3个月时,采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(the oswestry disability index,ODI)评估患者术后疼痛以及腰部功能恢复情况;依据MacNab标准评估总体预后,计算总优良率。结果观察组手术时间长于对照组,但术中出血量以及术后引流量均低于对照组,差异具有统计学意义(P<0.05);两组患者术前腰椎滑脱角分别为5.53°和5.42°,术后3个月依次下降至1.31°和1.35°,较术前下降明显(P<0.05),但组间比较差异无统计学意义(P>0.05);术后3d、1个月、3个月时观察组VAS、ODI评分均低于对照组,差异具有统计学意义(P<0.05);观察组总优良率为86.67%,高于对照组的63.33%,差异具有统计学意义(P<0.05)。并发症方面,观察组发生率为6.67%,而对照组为10.00%,两组间差异无统计学意义(P>0.05)结论 MIS-TLIF治疗腰椎滑脱症近期疗效显著,有助于腰椎功能恢复,且具有创伤小、恢复快等优点,值得临床推广。Objective To analyze the early curative effect and safety of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of lumbar spondylolisthesis.Methods 60cases of lumbar spondylolisthesis patients treated in our hospital during January 2015 to June 2017 were recruited in this study and randomly divided into observation group and control group.30 patients in observation group wase given MIS-TLIF surgical intervention,while another 30 patients in control group was given conventional posterior lumbar intervertebral fusion(PLIF).All the patients were followed up for least 3 months after operation.The difference of operation time,intraoperative blood transfusion and postoperative suction drainage between two groups were compared.Plain lumbar spine X-ray or CT examination was conducted preoperative and 3 months after operation to observe the change of spondylolisthesis in two groups.VAS and ODI scoring system were used to assess patients postoperative pain and lumbar function recovery before and 3 days,1month and 3 months after operation.The overall prognosis and fine rate were caculated according to the MacNab standard.Results The operating time in observation group was longer than control group,while the bed time,hospitalization time,intraoperative blood transfusion and postoperative suction drainage were lower than the control group(P<0.05).The spondylolisthesis were 5.53°and 5.42°in two groups,while they were descended to 1.31°and 1.35°respectively.In two groups,there was statistical difference before and after operation(P<0.05),while with no statistical difference between two groups(P>0.05).The VAS and ODI scores in observation group 3 days,1 month and 3month after operation were lower than that of control group(P<0.05).The fine rate in observation group was 86.67%and higher than 63.33%in control group(P<0.05).The incidence of complications,observation group was 6.67%,while the control group was 10.00%.There was no statistically significant difference between the two groups(P>0.05)

关 键 词：后路 腰椎 椎间融合术 微创经椎间孔入路椎体间融合术 腰椎滑脱症 疗效 

分 类 号：R681.57[医药卫生—骨科学]