Wiltse入路改良TLIF治疗伴有钙化或骨化的高位腰椎间盘突出症  

Modified TLIF in the treatment of upper lumbar disc herniation with calcification or ossification via Wiltse approach

作　　者：胡凌云 张建英[3] 刘浩[1] 张波[2] 苟林[2] 林宏[2] 宋跃明[1] 李永宁[2] HU Ling-yun;ZHANG Jian-ying;LIU Hao;ZHANG Bo;GOU Lin;LIN Hong;SONG Yue-ming;LI Yong-ning(Dept of Orthopaedics,West China Hospital,Sichuan University,Chengdu,Sichuan610041,China;Dept of Orthopaedics,Nanchong Central Hospital,the Second Clinical Medical College of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]四川大学华西医院骨科,四川成都610041 [2]川北医学院第二临床医学院四川南充市中心医院骨科,四川南充637000 [3]川北医学院第二临床医学院四川南充市中心医院影像中心,四川南充637000

出　　处：《临床骨科杂志》2019年第1期25-30,共6页Journal of Clinical Orthopaedics

基　　金：国家自然科学基金青年项目(编号:81100929)

摘　　要：目的探讨Wiltse入路改良经椎间孔腰椎间融合术(TLIF)治疗伴有钙化或骨化的高位腰椎间盘突出症的近期临床疗效及安全性。方法选择44例符合标准的伴有钙化或骨化的高位腰椎间盘突出症患者,根据治疗方法不同分为观察组(采用Wiltse入路改良TLIF,21例)和对照组(采用传统后正中入路TLIF,23例)。比较两组的手术情况、术后并发症、疼痛VAS评分、ODI、JOA评分。结果术中出血量、术后引流量、术后下地时间、术后住院时间观察组均明显少于对照组(P <0. 05);手术时间观察组长于对照组(P <0. 05)。患者均获得随访,时间8～15个月。术后1周、3个月,VAS评分、ODI、JOA评分观察组均明显优于对照组(P <0. 05)。术后6个月,VAS评分观察组优于对照组(P <0. 05),ODI及JOA评分两组比较差异均无统计学意义(P> 0. 05)。术后脑脊液漏、神经损伤或激惹发生率两组比较差异有统计学意义(P <0. 05),切口和硬脊膜撕裂发生率两组比较差异均无统计学意义(P> 0. 05)。结论 Wiltse入路改良TLIF治疗伴有钙化或骨化的高位腰椎间盘突出症可获得良好的疗效。Objective To investigate the clinical efficacy and safety of the modified transforaminal lumbar interbody fusion(TLIF)in the treatment of upper lumbar disc herniation with calcification or ossification via Wiltse approach.Methods A total of 44 patients with calcified or ossified upper lumbar disc herniation were selected and divided into the observation group(modified TLIF via Wiltse approach,21 cases)and the control group(TLIF via traditional posterior median approach,23 cases).The operation conditions,postoperative complications,pain VAS,ODI,and JOA score were compared between the two groups.ResultsIn the observation group,the intraoperative blood loss,postoperative drainage,postoperative down time,and postoperative hospitalization time were all significantly less than those in the control group(P<0.05);the operation time of the observation group was longer than that of the control group(P<0.05).All patients were followed up for 8~15 months.At 1 week and 3 months after surgery,the VAS,ODI,and JOA score in the observation group were significantly better than those in the control group(P<0.05).At 6 months after surgery,VAS in the observation group were significantly lower than those in the control group(P<0.05),there was no significant difference in ODI and JOA score between the two groups(P<0.05).There were significant differences between the two groups in the complications of cerebrospinal fluid leakage and nerve injury(P<0.05).No significant differences in the incidence of complications of incision and dural tear between the two groups were observed(P>0.05).Conclusions The modified TLIF with Wiltse approach in the treatment of upper lumbar disc herniation with calcification or ossification can get a good effect.

关 键 词：经椎间孔腰椎间融合术 腰椎间盘突出症 神经损害 围手术期 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]