显微镜与冷光源辅助经椎间孔椎间融合术治疗腰椎间盘突出症的对比分析  

Comparative analysis of treatment of lumbar disc herniation by intervertebral fusion with microscope and cold light source

作　　者：陈佳 王孟飞 张吉涛 李政[3] 郝定均[3] 单乐群 CHEN Jia;WANG Mengfei;ZHANG Jitao;LI Zhen;HAO Dingjun;SHAN Lequn(Department of Orthopedics,Tangdu Hospital,the Fourth Military Medical University,Xi’an 710038,China;Department of Orthopedics,No.988 Hospital of PLA Joint Logistics Support Force,Zhengzhou 450042,China;Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]空军军医大学唐都医院骨科,陕西西安710038 [2]联勤保障部队第九八八医院全军创伤骨科中心,河南郑州450042 [3]西安交通大学附属红会医院,陕西西安710054

出　　处：《现代医学》2020年第3期298-302,共5页Modern Medical Journal

基　　金：国家自然科学基金资助项目(30901784,81272072);陕西省社会发展科技攻关项目(2016SF-115)。

摘　　要：目的:对比显微镜和冷光源辅助经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎间盘突出症的手术相关指标、临床疗效及安全性。方法:回顾性分析空军军医大学唐都医院骨科2012年1月至2017年6月行显微镜或冷光源辅助MIS-TLIF治疗单节段腰椎间盘突出症患者的资料,其中显微镜组52例,冷光源组42例。比较两种术式的手术时间、术中出血量、术后引流量、术后下地时间、术后住院时间、术后3个月VAS评分、ODI指数、JOA评分、JOA改善率及术后并发症发生率。结果:与冷光源组相比,显微镜组手术时间差异无统计学意义[(149.0±19.2) min vs (153.6±26.4)min,t=0.962,P=0.338],但术中出血量少[(278.5±51.2) ml vs (348.8±52.4) ml,t=6.559,P<0.001],术后引流量少[(136.5±33.0) ml vs (231.4±35.2) ml,t=13.456,P<0.001],术后下地时间早[(2.2±0.8) d vs(3.6±0.9) d,t=7.948,P<0.001],术后住院天数短[(6.2±1.2) d vs (7.4±0.8) d,t=5.552,P<0.001],而术后并发症差异无统计学意义(7.69%vs 11.90%,χ^2=0.476,P=0.490)。术前与术后3个月显微镜组与冷光源组VAS差值[(4.1±0.9) vs (3.6±0.8),t=2.631,P=0.010]、ODI指数差值[(33.17±4.44) vs(29.90±5.88),t=3.081,P=0.003]、JOA评分差值[(9.8±3.0) vs (7.7±3.7),t=3.003,P=0.003]差异均有统计学意义;与冷光源组比较,显微镜组JOA改善率明显提高[(77±8.74)%vs (67±12.01)%,χ^2=115.362,P=0.027]。结论:显微镜或冷光源辅助下MIS-TLIF治疗腰椎间盘突出症均安全有效,而相对冷光源辅助,显微镜辅助MIS-TLIF术中出血更少,术后引流更少,疗效更好。Objective: To observe and compare the clinical effects and safety of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar disc herniation between the assistance of microscope and cold light source.Methods: From January 2012 to June 2017,94 patients with single-segment LDH accepted in our department were treated with MIS-TLIF assisted by microscope or the cold light illumination.In this retrospective study,surgical information,such as operative time,intraoperative hemorrhage,postoperative drainage,postoperative bedridden time,postoperative hospitalization days,pre-operative and post-operative VAS score,ODI index,JOA score,the improvement rate of JOA and perioperative complications,were collected and compared between the patients who received the two different treatments.Results: As for the intraoperative hemorrhage, postoperative drainage, postoperative ambulation time, and postoperative hospitalization days,microscope assisted group revealed better clinical effects than cold light group(P<0.05).The post-operative VAS score,JOA scores and ODI index,and the improvement rate of JOA in both groups were better than that of preoperation in microscope assisted group(P<0.05).However,no significant differences were found in operative time and postoperative complication between the two groups(P>0.05).Conclusion: Microscope assisted MISTLIF is an effective and safe technique with lower intraoperative hemorrhage,less postoperative drainage and lower postoperative complications in the treatment of lumbar disc herniation.

关 键 词：腰椎间盘突出症 经椎间孔腰椎椎间融合术 微创手术 显微镜 冷光源 

分 类 号：R681.53[医药卫生—骨科学]