多裂肌劈开入路微创行TLIF治疗腰骶段退变性疾病的疗效  

Clinical effect of minimally invasive transforaminal lumbar interbody fusion via multifidus⁃splitting ap⁃proach for lumbosacral degenerative diseases

作　　者：李佳[1] 张欣[1] 王磊[1] 单中书[1] 刘伟[1] 李涛[1] LI Jia;ZHANG Xin;WANG Lei;SHAN Zhongshu;LIU Wei;LI Tao(Department of Orthopaedics,Qinghai Provincial People′s Hospital,Xining 810007,China)

机构地区：[1]青海省人民医院骨科,西宁810007

出　　处：《实用医学杂志》2022年第20期2608-2613,共6页The Journal of Practical Medicine

基　　金：青海省卫健委指导性计划课题(编号:2019⁃wjzdx⁃10)。

摘　　要：目的探讨多裂肌劈开入路微创经椎间孔腰椎椎间融合术(transforaminal lumbar interbodyfu⁃sion,TLIF)治疗腰骶段退变性疾病的临床疗效。方法选取2017年2月至2021年2月符合纳入标准的127例腰骶椎单节段退变的患者作为研究对象。根据手术入路不同分为观察组(n=62)和对照组(n=65)。观察组患者行正中切口后劈开多裂肌后行TLIF手术治疗,对照组行传统剥离椎旁肌行TLIF手术。比较两组患者治疗前后及术后1年随访时腰椎Oswestry功能障碍指数(ODI)及JOA评分,疼痛视觉模拟量表(VAS)评分,术中出血量、手术时间、术后引流量、住院时间、多裂肌脂肪浸润等级等相关指标评估。结果观察组患者术中出血量、手术时间、术后引流量及住院时间与对照组比较,均低于对照组,差异有统计学意义(P<0.05);两组患者术前的ODI、JOA评分差异无统计学意义(P>0.05),术后3 d及1年随访时观察组患者ODI评分低于对照组,JOA评分高于对照组,差异均有统计学意义(P<0.05);两组患者的术前疼痛VAS评分差异无统计学意义(P>0.05),观察组患者术后3 d及1年随访时VAS评分均低于对照组,差异有统计学意义(P<0.05);术后1年,观察组多裂肌脂肪浸润等级级别较高的比例与对照组相比明显较低,差异有统计学意义(P<0.05)。结论相对于传统入路,多裂肌劈开入路行TLIF治疗单节段腰骶段退变性疾病能明显改善患者腰椎功能,且出血少,术后疼痛小、手术时间短、住院时间短等优势,减轻多裂肌脂肪化,保留其功能,具有微创优势,促进患者围手术期快速康复。Objective To investigate the clinical effect of minimally invasive transforaminal lumbar inter⁃body fusion(TLIF)by multifidus⁃splitting approach in the treatment of lumbosacral degenerative diseases.Methods A total of 127 patients with lumbosacral single⁃level degeneration who met the inclusion criteria from February 2017 to February 2021 were selected as the study subjects.According to different surgical approaches,the patients were divided into treatment group(n=62)and control group(n=65).Patients in the treatment group received TLIF surgery after median incision and splitting of multifidus muscle,while patients in the control group received TLIF surgery after traditional paravertebral muscle dissection.Lumbar Oswestry Disability Index(ODI)and JOA scores,visual analogue scale(VAS)scores,intraoperative blood loss,operation time,postoperative drainage,length of hospital stay,and multifidus fat infiltration grade were compared between the two groups before and after treatment and at 1⁃year follow⁃up.Results The amount of intraoperative blood loss,operation time,postoperative drainage volume and length of hospital stay in the treatment group were lower than those in the control group,with statistical significance(P<0.05).There were no statistically significant differences in preoperative ODI and JOA scores between 2 groups(P>0.05),but ODI score in treatment group was lower than control group and JOA score was higher than control group at 3 days and 1 year follow⁃up after surgery,with statistically significant differences(P<0.05).There was no statistically significant difference in preoperative VAS scores between 2 groups(P>0.05),and VAS scores of 3 days and 1 year after surgery in the treatment group were lower than those in the control group.The difference was statistically significant(P<0.05).One year after surgery,the proportion of higher fat infiltration grade of multifidus muscle in the treatment group was significantly lower than that in the control group,and the difference was statistically signi

关 键 词：多裂肌劈开 微创 经椎间孔腰椎椎间融合术 腰骶段 单节段 腰椎退变 

分 类 号：R681.57[医药卫生—骨科学]