脊柱内镜下经椎间孔腰椎椎间融合术治疗腰椎间盘突出症伴腰椎不稳的早期临床研究  

Early efficacy of endoscopic transforaminal lumbar interbody fusion in the treatment of lumbar disc herniation with lumbar instability

作　　者：孙凤龙[1] 梁庆晨 王宏庆 刘祖耀[1] 李富[1] 董婕[1] 闫明[2] 刁文博 SUN Fenglong;LIANG Qingchen;WANG Hongqing;LIU Zuyao;LI Fu;DONG Jie;YAN Ming;DIAO Wenbo(No.2 Department of Orthopedics,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing 100144;Department of Spinal Surgery,First Hospital of Bethune,Jilin University,Changchun 130021;Department of Orthopedics,Zhoukou Union Osteological Hospital,Zhoukou 466000,Henan,China)

机构地区：[1]首都医科大学附属北京康复医院骨二科,北京100144 [2]吉林大学白求恩第一医院脊柱外科,长春130021 [3]周口协和骨科医院骨科,河南周口466000

出　　处：《中华骨与关节外科杂志》2019年第10期754-760,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:腰椎间盘突出症伴腰椎不稳的发生率逐年增加,如何有效使用脊柱内镜技术进行腰椎融合治疗是目前研究的方向。目的:评价全可视脊柱内镜下经椎间孔腰椎椎间融合术(Endo-TLIF)治疗腰椎间盘突出症伴腰椎不稳的早期临床疗效。方法:回顾性分析2016年1月至2017年12月使用Endo-TLIF技术治疗的腰椎间盘突出症伴腰椎不稳患者38例,记录手术时间、术中出血量、切口长度、住院时间及并发症等临床指标。采用Oswestry功能障碍指数(ODI)评估腰椎功能,疼痛视觉模拟评分(VAS)评估腰痛及腿痛。术前和术后1、6个月和术后1年随访行X线片、CT及MRI,评估椎间隙高度、腰椎前凸角、硬膜囊面积、椎间孔面积及融合率,并进行统计学分析。结果:手术时间为65~155 min,平均为(97±11)min;术中出血量为40~110 ml,平均为(65±11)ml。切口长度为1.3~3.5 cm,平均为(2.2±1.8)cm。住院时间为3~16 d,平均为(10.3±2.4)d。所有患者均获得随访,随访时间为12~28个月,平均(18.6±3.3)个月。ODI由术前的(59.2%±18.3%)下降至术后1年的(19.5%±9.2%);腰痛VAS评分由术前的(6.9±1.8)分下降至术后1年的(1.7±1.3)分;下肢痛VAS评分由术前的(5.8±2.2)分下降至术后1年的(1.3±1.2)分,差异均有统计学意义(P<0.05)。椎间隙高度由术前的(6.4±1.4)mm改善为术后1年的(11.6±1.5)mm;腰椎前凸角由术前的(45.7°±9.3°)恢复至术后1年(54.3°±10.2°);硬膜囊横截面积由术前的(78.6±28.4)mm2增加至术后1年的(112.9±18.4)mm^2;椎间孔面积由术前的(138.7±25.8)mm^2恢复至术后1年的(157.1±19.5)mm^2,差异均有统计学意义(P<0.05)。术后1年随访时椎体融合率为100%,随访期间无一例发生严重并发症。结论:Endo-TLIF治疗腰椎间盘突出症伴腰椎不稳,可以改善患者临床症状,早期疗效满意,其长期疗效有待进一步观察。Background:The incidence of lumbar disc herniation with lumbar instability is increasing year by year. How to effectively use spinal endoscopy for lumbar fusion is the current research direction. Objective:To evaluate the short-term clinical efficacy of endoscopic transforaminal lumbar interbody fusion(Endo-TLIF) in the treatment of lumbar disc herniation with lumbar instability. Methods:A retrospective analysis of 38 patients with lumbar disc herniation and lumbar instability treated by Endo-TLIF in our department from January 2016 to December 2017 was conducted. The operation time, intraoperative bleeding volume, incision length, hospital stay and complications were recorded. Oswestry disability index(ODI) was used to evaluate lumbar spine function, and visual analogue scale(VAS) was used to evaluate low back pain and leg pain. X-ray examination was performed to evaluate the height of intervertebral space, lumbar lordosis angle and fusion rate, and CT and MRI were performed to measure the areas of dural sac and intervertebral foramen before the operation, and 1 month, 6 months and 1 year after the operation. Statistical analysis was conducted. Results:All patients were followed up for an average of(18.6±3.3) months(range, 12-28 months). The average operation time was(97±11) min(range, 65-155 min);the average volume of bleeding during the operation was(65±11) ml(range, 40-110 ml);the average length of incision was(2.2±1.8) cm(1.3-3.5 cm);the average length of hospitalization was(10.3±2.4) days(3-16 days). ODI decreased from 59.2%±18.3% before operation to 19.5%±9.2% one year after operation;VAS score of low back pain decreased from 6.9±1.8 before operation to 1.7±1.3 one year after operation;VAS score of lower limb pain decreased from 5.8±2.2 before operation to 1.3±1.2 one year after operation(all P<0.05). The height of intervertebral space increased from(6.4±1.4) mm before operation to(11.6±1.5) mm 1 year after operation;the lumbar lordosis angle was restored from(45.7°±9.3°) before operation t

关 键 词：腰椎 脊柱融合术 内镜 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]