微创经椎间孔入路腰椎椎间融合术与后路腰椎椎间融合术治疗全椎板切除术后复发性腰椎椎间盘突出症  

Minimally invasive transforaminal lumbar interbody fusion and posterior lumbar interbody fusion for treatment of recurrent lumbar disc herniation after total laminectomy

作　　者：郭晓帅 韩振川 张春玲[4] 毛克亚 安小刚 Guo Xiaoshuai;Han Zhenchuan;Zhang Chunling;Mao Keya;An Xiaogang(Department of Graduate School,Hebei North University,Zhangjiakou 075000,Hebei,China;Department of Orthopaedics,Hangang Hospital,Handan 056001,Hebei,China;Department of Orthopaedics,PLA Rocket Force Characteristic Medical Center,Beijing 100088,China;Department of Orthopaedics,First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China;Department of Orthopaedics,Fourth Medical Centre of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]河北北方学院研究生院,张家口075000 [2]邯郸邯钢医院骨科,邯郸056001 [3]中国人民解放军火箭军特色医学中心骨科,北京100088 [4]河北北方学院附属第一医院骨科,张家口075000 [5]中国人民解放军总医院第四医学中心骨科医学部,北京100853

出　　处：《脊柱外科杂志》2025年第1期6-11,共6页Journal of Spinal Surgery

摘　　要：目的探讨微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)与后路腰椎椎间融合术(PLIF)治疗全椎板切除术后复发性腰椎椎间盘突出症(LDH)的临床疗效。方法2015年6月—2021年1月,邯郸邯钢医院收治全椎板切除术后复发性LDH患者59例,其中31例采用MIS-TLIF治疗(MIS-TLIF组),28例采用PLIF治疗(PLIF组)。记录并比较2组手术时间、术中透视时间、术中出血量、术后引流量、术后3 d C反应蛋白(CRP)水平、卧床时间、住院时间,以及术前、术后1个月、末次随访时腰痛和腿痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI),末次随访时采用改良MacNab标准评价临床效果。术后6、12个月复查腰椎正侧位X线评估内固定位置,采用Bridwell融合标准评价融合情况。结果所有手术顺利完成。2组手术时间、早期并发症发生情况差异无统计学意义(P>0.05)。MIS-TLIF组术中出血量、术后引流量、术后3 d CRP水平、卧床时间和住院时间优于PLIF组,差异均有统计学意义(P<0.05)。MIS-TLIF组术中透视时间较PLIF组长,差异有统计学意义(P<0.05)。所有患者随访15~24(19.61±2.82)个月。2组术后腰痛和腿痛VAS评分及ODI较术前降低,差异均有统计学意义(P<0.05);术后各时间点VAS评分和ODI组间差异无统计学意义(P>0.05)。2组患者术后均获得BridwellⅠ级和Ⅱ级融合,改良MacNab标准评价疗效均为优良,组间差异无统计学意义(P>0.05)。结论采用MIS-TLIF和PLIF治疗全椎板切除术后复发性LDH均可获得良好疗效。MIS-TLIF具有手术创伤小、患者术后恢复快等优点,在术中出血量、卧床时间、住院时间等方面更具优势;但MIS-TLIF操作难度大,对术者技术要求高,且术中医患辐射暴露增加问题同样不可忽视。Objective To investigate the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and posterior lumbar interbody fusion(PLIF)in the treatment of recurrent lumbar disc herniation(LDH)after total laminectomy.Methods From June 2015 to January 2021,Hangang Hospital admitted 59 patients with recurrent LDH after total laminectomy,including 31 patients treated with MIS-TLIF(MIS-TLIF group)and 28 with PLIF(PLIF group).The operation time,intraoperative fluoroscopy time,intraoperative blood loss,postoperative drainage volume,C-reactive protein(CRP)level at postoperative 3 d,bed rest time,hospital stay,as well as the visual analog scale(VAS)scores for back pain and leg pain and Oswestry disability index(ODI)at pre-operation,postoperative 1 month and at the final follow-up of the 2 groups were recorded and compared.The clinical efficacy was evaluated by the modified MacNab criteria at the final follow-up.At postoperative 6 and 12 months,anteropostenior and lateral roentgenographs were performed to evaluate the position of internal fixation,and the Bridwell fusion criteria were used to assess the fusion status.Results All the operations were successfully completed.There was no statistically significant difference in operation time and early complications between the 2 groups(P>0.05).The intraoperative blood loss,postoperative drainage volume,CRP level at postoperative 3 d,bed rest time and hospital stay of the MIS-TLIF group were all better than those of the PLIF group,and the differences were statistically significant(P<0.05).The intraoperative fluoroscopy time in the MIS-TLIF group was longer than that in the PLIF group,and the difference was statistically significant(P<0.05).All the patients were followed up for 15-24(19.61±2.82)months.The VAS scores of back pain and leg pain and ODI at post-operation of the 2 groups decreased significantly compared to those at pre-operation,and the differences were statistically significant(P<0.05).There was no statistically significant difference in th

关 键 词：腰椎 椎间盘退行性变 脊柱融合术 外科手术 微创性 再手术 

分 类 号：R681.5333[医药卫生—骨科学]