经椎间孔椎体间融合与对侧间接减压腰椎翻修术  

Transforaminal interbody fusion combined with contralateral indirect decompression as revision lumbar surgery

作　　者：王钧 伍振威 段祥林 杨操[2] 吴星火[2] WANG Jun;WU Zhen-wei;DUAN Xiang-lin;YANG Cao;WU Xing-huo(Department of Orthopedics,Wuhan Red Cross Hospital,Wuhan 430022,China;Department of Orthopedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]武汉市红十字会医院骨科,湖北武汉430022 [2]华中科技大学同济医学院附属协和医院骨科,湖北武汉430022

出　　处：《中国矫形外科杂志》2021年第11期961-965,共5页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:NSFC,81974349)。

摘　　要：[目的]探讨经椎间孔腰椎椎间融合联合对侧潜行减压术(transforaminal lumbar interbody fusion combined with contralateral indirect decompression,c-TLIF)在腰椎翻修中的临床疗效及其并发症。[方法]回顾性分析2015年3月—2019年3月本院腰椎翻修手术的48例患者。依据临床症状与影像所见,26例患者行TLIF(TLIF组),22例患者行c-TLIF。比较两组患者围手术期、随访和影像资料。[结果]TLIF组并发脑脊液漏11例,神经根损伤4例,伤口延迟愈合6例;c-TLIF组并发脑脊液2例,神经根损伤1例,伤口延迟愈合1例;前者的并发症的发生率明显高于后者(P<0.05)。两组患者在手术时间、术中出血量和手术切口长度、术中X线曝露时间的差异均无统计学意义(P>0.05)。所有患者随访6~36个月,随时间推移,两组患者VAS评分显著降低(P<0.05),而JOA评分显著增加(P<0.05);相应时间点,两组间VAS评分和JOA评分的差异均无统计学意义(P<0.05)。影像方面,与术前相比,末次随访时两组患者椎间隙高度、LL和椎管面积均显著增加(P<0.05)。末次随访时,两组在椎间隙高度、LL和椎管面积的差异均无统计学意义(P<0.05)。至末次随访时,两组患者均达到骨性椎间融合,均无内固定松动、断裂、融合器移位及下沉等不良征像。[结论]经椎间孔腰椎椎间融合联合对侧潜行减压术能够实现充分减压和可靠椎间融合的目的,手术并发症发生率低,临床疗效满意。[Objective]To explore the clinical efficacy and complications of transforaminal lumbar interbody fusion(TLIF)combined with contralateral indirect decompression(c-TLIF)as revision lumbar surgery.[Method]A retrospective study was conducted on 48 patients who underwent revision lumbar surgery in our hospital from March 2015 to March 2019.According to clinical symptoms and imaging findings,26 patients received TLIF only(TLIF group),while the remaining 22 patients had TLIF combined with contralateral indirect decompression performed(c-TLIF group).The patients in the two groups were compared regarding to documents of perioperative period,follow-up and radiographs.[Results]The TLIF group had cerebrospinal fluid leakage in 11 cases,nerve root injury in 4 cases and delayed wound healing in 6 cases,in contrast,the c-TLIF group had cerebrospinal fluid leakage in 2 cases,nerve root injury in 2 cases,and delayed wound healing in 1 case only;the former was of significantly higher complication occurrence than the latter(P<0.05).However,there were no significant differences in the operation time,intraoperative blood loss,surgical incision length,and intraoperative X-ray exposure time between the two groups(P>0.05).All patients were followed up for 6~36 months.The VAS scores decreased significantly(P<0.05),while the JOA scores increased significantly in both groups over time(P<0.05),although the differences in term of the VAS and JOA were not statistically significant between the two groups at any corresponding time point(P<0.05).Regarding imaging assessments,the intervertebral space height,lumbar lordosis angle(LL)and spinal canal area significantly increased at the latest follow up compared with those preoperatively(P<0.05),nevertheless no significant differences between the two groups in abovementioned radiographic parameters were noticed at the latest follow up(P<0.05).By the time of the latest follow-up,all patients in both groups achieved bony intervertebral fusion,while without signs of loosening and breaking of pedicle sc

关 键 词：经椎间孔腰椎椎间融合术 间接减压 神经根损伤 脑脊液漏 

分 类 号：R687[医药卫生—骨科学]