改良显微内窥镜下经椎间孔入路椎间融合术治疗退变性腰椎滑脱症  

Modified microendoscopic transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis

作　　者：李树文[1] 王宇鹏[1] 杜志才[1] 杨铁翼[1] 吴一民[1] 银和平[1] LI Shu-wen;WANG Yu-peng;DU Zhi-cai;YANG Tie-yi;WU Yi-min;YIN He-ping(Department of Minimal Invasive Spine Surgery. The Second Affiliated Hospital,Inner Mongolia Medical University,Hohhot 010030,China)

机构地区：[1]内蒙古医科大学第二附属医院微创脊柱外科

出　　处：《中国矫形外科杂志》2019年第19期1734-1738,共5页Orthopedic Journal of China

摘　　要：[目的]探讨显微内窥镜下改良经椎间孔入路椎间融合术治疗退变性腰椎滑脱症优缺点。[方法]回顾分析2015年7月~2017年7月在本科行显微内窥镜下椎间融合患者129例,根据手术方法不同分为两组。59例采用经典入路,70例采用改良入路。记录并比较两组的手术时间、出血量、并发症及近期疗效。[结果]所有手术均顺利完成,经典入路组术中2例出现硬脊膜撕裂,经头低脚高位1周左右愈合;2例神经根损伤术后出现一过性腓骨长短肌肌力下降,经对症神经营养治疗2~4周左右恢复正常,1例切口延期愈合,总并发症发生率11.86%。改良入路组出现1例一过性腓骨长短肌肌力下降,经对症神经营养治疗2周左右恢复正常,总并发症发生率1.43%。两组并发症发生率差异有统计学意义(P<0.05)。改良组手术时间、术中失血量显著优于经典组(P<0.05)。两组患者随访24~48个月,平均(30.50±15.25)个月。随术后时间延长,两组患者的VAS和ODI评分均显著减少(P<0.05),而JOA评分显著增加(P<0.05)。术后3个月、末次随访时,两组间VAS、ODI和JOA评分的差异均无统计学意义(P>0.05)。影像评估方面,两组患者均达到骨性融合,两组融合时间的差异无统计学意义(P>0.05)。至末次随访时,两组129例患者均末见内固定物松动、移位或断裂。[结论]显微内窥镜下改良经椎间孔入路椎间融合术手术时间短、出血少、操作相对简单,并发症发生率低,临床疗效满意。[Objective] To exlpore the advantage and disadvantage of the modified microendoscopic transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spondylolisthesis.[Methods] A retrospective study was conducted on 129 patients who underwent microendoscopic TLIF for degenerative lumbar spondylolisthesis from July 2015 to July 2017 in our department, including 59 patients who had the surgical procedure performed through the classic approach, and 70 patients who received operations through the modified approach. The operation time, blood loss, complications and short term therapeutic outcomes were compared between the two groups.[Results] All the patients had the surgical procedures performed smoothly. In term of early complications, 2 patients had dural tear which cured 2 weeks later, 2 got nerve root injuries presenting weakness of peroneal muscle that returned to normal 2~4 weeks later after neurotrophic drug therapy, and 1 patient had delayed incision healing, associated with a total complication rate of 11.86% in the classic group. By contrast, only a patient in the modified group had peroneal weakness due to nerve root traction which recovered to normal 2 weeks later, accounted for 1.43%, there was a statistically significantly difference between them (P<0.05). In addition, the modified group proved significantly superior to the classic group regarding to operation time and blood loss (P<0.05). The follow-up period lasted for 24~48 months, with an average of (30.50±15.25) months. The VAS and ODI scores significantly decreased (P<0.05), while the JOA score significantly increased as time went postoperatively in both groups (P<0.05), although no statistically significant differences were found at 3 months and the latest follow up between the two groups (P>0.05). In term of radiographic assessments, all the patients in both groups achieved bony fusion, without a statistically significant difference in fusion time between them (P>0.05). To the latest follow up, no loosening and breaking of the implants w

关 键 词：脊柱滑脱 显微内窥镜手术 经椎间孔入路腰椎融合术 

分 类 号：R681.57[医药卫生—骨科学]