管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术治疗单节段腰椎退行性疾病  

Bilateral decompression via single incision with tubular channel in minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases

作　　者：荚龙 曾至立[2] 于研[2] 高如峰 潘福根 程黎明[2] Jia Long;Zeng Zhili;Yu Yan;Gao Rufeng;Pan Fugen;Cheng Liming(Department of Orthopaedics,Qingpu Branch of Zhongshan Hospital,Fudan University,Shanghai 201799,China;Department of Spinal Surgery,Tongji Hospital,Tongji University,Shanghai 200065,China)

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201799 [2]同济大学附属同济医院脊柱外科,上海200065

出　　处：《脊柱外科杂志》2021年第1期21-25,共5页Journal of Spinal Surgery

摘　　要：目的探讨管状通道下单侧入路双侧减压微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗单节段腰椎退行性疾病的临床疗效。方法2013年11月—2016年2月,同济大学附属同济医院采用管状通道下单侧入路双侧减压MIS-TLIF治疗28例单节段腰椎退行性疾病患者。记录手术时间、术中出血量、术后引流量;测量手术前后及末次随访时手术节段椎间隙高度、腰椎前凸角;采用疼痛视觉模拟量表(VAS)评分评估患者腰腿痛程度,采用Oswestry功能障碍指数(ODI)评估患者腰椎功能;末次随访以Bridwell标准评价椎间融合情况,以MacNab标准评价临床疗效。结果所有手术顺利完成,所有患者随访17~36个月。末次随访时,手术节段椎间隙高度由术前(0.98±0.23)cm增加至(1.22±0.18)cm,腰椎前凸角由术前31.08°±12.63°增加至33.81°±11.27°,腰痛VAS评分由术前(5.96±0.84)分降低至(1.61±0.50)分,腿痛VAS评分由术前(6.46±0.74)分降低至(1.57±0.57)分,ODI由术前(59.75±4.83)%降低至(16.64±2.09)%,差异均有统计学意义(P<0.05)。末次随访时Ⅰ级和Ⅱ级融合26例(92.9%),临床疗效优18例,良8例,可2例。结论采用单侧入路双侧减压MIS-TLIF治疗单侧神经根性症状伴中央性椎管狭窄、单侧神经根性症状Ⅰ度腰椎滑脱患者疗效确切。Objective To investigate the clinical effect of bilateral decompression via single incision with tubular channel in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for lumbar degenerative diseases.MethodsFrom November 2013 to February 2016,28 patients with single level lumbar degenerative disease were treated by MIS-TLIF(bilateral decompression via single incision with tubular channel)in Tongji Hospital Affiliated to Tongji University.The operation time,intraoperative blood loss and postoperative drainage volume were recorded.At pre-operation,post-operation and the final follow-up,the intervertebral space height and lumbar lordosis angle were measured;the low back and leg pain was evaluated by visual analogue scale(VAS)score;the lumbar function was evaluated by Oswestry disability index(ODI).At the final follow-up,the fusion was evaluated by Bridwell criteria and the clinical effect by MacNab criteria.Results All the operations were successfully completed.All the patients were followed up for 17-36 months.At the final follow-up,the intervertebral space height increased from(0.98±0.23)cm to(1.22±0.18)cm,the lumbar lordosis angle increased from 31.08°±12.63°to 33.81°±11.27°,the VAS score of low back pain decreased from 5.96±0.84 to 1.61±0.50,the VAS score of leg pain decreased from 6.46±0.74 to 1.57±0.57,and ODI decreased from(59.75±4.83)%to(16.64±2.09)%,and the differences were statistically significant(P<0.05).At the final follow-up,26 cases(92.9%)had gradesⅠandⅡfusion.The clinical effect was excellent in 18 cases,good in 8 and fair in 2.Conclusion Bilateral decompression via single incision with tubular channel in MIS-TLIF is effective in the treatment of unilateral nerve root symptoms with central spinal stenosis and unilateral nerve root symptoms with gradeⅠlumbar spondylolisthesis.

关 键 词：腰椎 脊椎滑脱 椎管狭窄 外科手术 微创性 脊柱融合术 

分 类 号：R681.533[医药卫生—骨科学]