改良微创经椎间孔入路腰椎椎间融合术治疗腰椎退行性疾病的疗效  

Efficacy of modified minimally invasive transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases

作　　者：张国腾 王毅 张志达 周沛 周剑鹏 ZHANG Guoteng;WANG Yi;ZHANG Zhida;ZHOU Pei;ZHOU Jianpeng(Department of Traditional Chinese Medicine Orthopaedics,The Affiliated Guangzhou Hospital of TCM of Guangzhou University of Chinese Medicine,Guangzhou 510130,China;Department of Traditional Chinese Medicine Orthopaedics,The Affiliated Traditional Chinese Medicine Hospital,Guangzhou Medical University,Guangzhou 510130,China)

机构地区：[1]广州中医药大学附属广州中医医院中医骨伤科,广东广州510130 [2]广州医科大学附属中医医院中医骨伤科,广东广州510130

出　　处：《分子影像学杂志》2025年第4期459-465,共7页Journal of Molecular Imaging

基　　金：广东省医学科学技术研究基金项目(A2023282)。

摘　　要：目的探讨改良微创经椎间孔入路腰椎椎间融合术(mis-TLIF)治疗腰椎退行性疾病的临床疗效。方法选取2021年1月~2022年11月于广州中医药大学附属广州中医医院骨科采用改良mis-TLIF术治疗的39例腰椎退行性疾病患者,其中男15例,女24例,年龄28~90(66.08±13.95)岁;接受改良mis-TLIF术的患者12例,接受改良mis-TLIF术结合ULBD术的患者27例。收集并记录手术时间、术中出血量、并发症情况;术前、术后1周、3月及末次随访的腰腿痛的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);末次随访以MacNab标准评价临床疗效。结果所有患者手术顺利完成,均获得随访,随访时间为12~28(17.49±5.05)月。手术时间76~190(106.67±33.01)min,术中出血量110~447(225.38±87.90)mL,术中发生1例硬脊膜撕裂,行可吸收脑脊膜修补片修复硬脊膜后无脑脊液漏,术中无神经损伤,术后37例伤口I期愈合,1例切口出现表浅感染,给予敏感抗生素抗感染及对症清创处理后伤口愈合,1例出现切口缝线反应,单纯进行对症清创处理后伤口愈合,2例均未发生深部感染。术中术后所有患者无心脑血管意外发生。术前及术后1周、3月、末次随访的腰痛VAS评分分别为8.27±0.76、2.49±0.76、1.46±0.64、0.94±0.48,腿痛VAS评分分别为8.69±0.68、1.91±0.63、1.16±0.54、0.78±0.43,ODI评分分别为81.98±10.07、27.47±9.31、18.98±7.37、14.66±5.54。术后各时间点腰腿痛VAS评分、ODI均较术前改善,差异有统计学意义(P<0.05)。腰腿痛VAS评分术后各时间点间两两比较差异均有统计学意义(P<0.05)。末次随访时MacNab标准优20例,良16例,可3例,优良率92.31%。结论改良mis-TLIF术治疗腰椎退行性疾病是一种微创、安全有效的手术方法,但其远期临床疗效仍需进一步随访观察。Objective To investigate the clinical efficacy of modified minimally invasive lumbar interbody fusion(mis-TLIF)in the treatment of lumbar degenerative diseases.Methods A retrospective analysis was conducted on 39 patients with lumbar degenerative diseases treated with modified mis-TLIF surgery at the Department of Orthopedics,the Affiliated Guangzhou Hospital of TCM of Guangzhou University of Chinese Medicine from January 2021 to November 2022,including 15 males and 24 females,aged from 28-90(66.08±13.95)years old.12 patients underwent modified mis-TLIF surgery,while 27 patients underwent modified mis-TLIF combined with ULBD surgery.Surgical time,intraoperative bleeding volume,and complications were recorded.Visual analog scale(VAS)scores for low back and leg pain,as well as Oswestry disability index(ODI),were collected before surgery,1 week and 3 months after surgery,and at the final follow-up.The MacNab criteria were employed to evaluate the clinical efficacy at the final follow-up.Results All patients underwent surgery successfully and were followed up for 12-28(17.49±5.05)months.The operation time ranged from 76-190(106.67±33.01)min,and the intraoperative bleeding volume ranged from 110-447(225.38±87.90)mL.One case of dural matter tear occurred during the surgery,which was repaired with an absorbable dural patch without subsequent cerebrospinal fluid leakage.No nerve injuries were observed in all cases.Postoperatively,37 cases achieved primary healing of wounds;1 case developed superficial infection at the incision site,and the wound healed after receiving sensitive antibiotics and symptomatic debridement;Another case presented with a suture reaction at the incision,which resolved after symptomatic debridement alone;Deep infection did not occur in either case.No cardiovascular or cerebrovascular accidents occurred in any patient during or after surgery.The VAS scores for low back pain at preoperative,1 week postoperative,3 months postoperative,and the final follow-up were 8.27±0.76,2.49±0.76,1.46±0.64,

关 键 词：微创经椎间孔入路腰椎椎间融合术 腰椎退行性疾病 腰腿痛 

分 类 号：R687.3[医药卫生—骨科学]