微创经椎间孔入路腰椎椎间融合术中应用单/双切口完成双侧内固定治疗腰椎退行性疾病  

Bilateral internal fixation through single/double incision in minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases

作　　者：李锦华[1] 赵宙[1] 王伟[1] 周鹰飞[1] 李安军[1] 杨祖清[1] LI Jin-hua;ZHAO Zhou;WANG Wei;ZHOU Ying-fei;LI An-jun;YANG Zu-qing(Department of Spinal Surgery,People’s Hospital,Hubei University of Medicine,Shiyan 442000,Hubei,China)

机构地区：[1]湖北医药学院十堰市人民医院脊柱外科

出　　处：《脊柱外科杂志》2019年第3期183-186,共4页Journal of Spinal Surgery

基　　金：2016年十堰市科学技术研究与开发项目(16Y45)

摘　　要：目的 探讨并分析微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)中应用单/双切口完成双侧内固定治疗腰椎退行性疾病的效果。方法 回顾性分析2013年2月—2016年2月本院MIS-TLIF治疗的86例腰椎退行性疾病患者临床资料,其中采用单侧切口完成双侧内固定组40例(试验组),采用双侧切口完成双侧内固定组46例(对照组)。采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)在术前,术后1d,术后3、6、12个月评估2组患者疼痛程度及腰椎功能;记录2组患者切口长度、术中出血量、手术时间、卧床时间、住院时间、并发症发生情况及融合情况等信息。结果 所有手术均顺利完成。试验组平均切口长度、手术时间、术中出血量、卧床时间、住院时间均优于对照组,差异均有统计学意义(P<0.05)。2组患者术前腰椎功能优良率和VAS评分比较差异无统计学意义(P>0.05);试验组术后3、6个月腰椎功能优良率明显高于对照组,差异有统计学意义(P<0.05),而术后1d、12个月组间差异无统计学意义(P>0.05);试验组术后1d、3个月VAS评分明显低于对照组,差异有统计学意义(P<0.05),而术后6、12个月组间差异无统计学意义(P>0.05)。结论 2种方式完成双侧内固定在MIS-TLIF中应用效果相当,但单侧切口较双侧内固定具有创口更小,术中出血量更少,愈合时间、卧床时间及住院时间更短,且可减轻术后疼痛,加速腰椎功能恢复等优点。Objective To investigate and analyze the effect of bilateral internal fixation through single/double incision in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for lumbar degenerative diseases.Methods From February 2013 to February 2016,clinical data of 86 patients with lumbar degenerative disease treated with MIS-TLIF were retrospectively analyzed,including 40 cases receiving bilateral internal fixation through single incision(experiment group)and 46 cases receiving bilateral internal fixation through double incision(control group).Visual analogue scale(VAS)score and Oswestry disability index(ODI)were used to evaluate the pain and lumbar function in the 2 groups at per-operation and postoperative 1 d,3 months,6 months and 12 months.Incision length,intraoperative blood loss,operation time,time in bed,hospital stay,complications and fusion condition were recorded in the 2 groups.Results All the patients completed the operation successfully.The mean incision length,operation time,intraoperative blood loss,time in bed and hospital stay were better in the experiment group than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in VAS score and excellent and good rate of lumbar function between the 2 groups at pre-operation(P>0.05).The excellent and good rate of lumbar function in the experiment group was significantly higher than that in the control group at postoperative 3 and 6 months(P<0.05);there was no significant difference between the 2 groups at postoperative 1 d and 12 months(P>0.05).The VAS score of the experiment group was significantly lower than that of the control group at postoperative 1 d and 3 months(P<0.05);there was no significant difference between the 2 groups at postoperative 6 and 12 months(P>0.05).Conclusion Two methods for bilateral internal fixation have the same effect in MIS-TLIF,but single incision has the advantages of smaller wound,less bleeding,shorter healing time,bed rest and hospital stay,and

关 键 词：腰椎 椎间盘退行性变 脊柱融合术 外科手术 微创性 内固定器 

分 类 号：R681.533[医药卫生—骨科学]