| 胡巍然,宋月鹏,施新革,马浩浩,王红强,邵佳,张锴,高延征*.微创经椎间孔入路腰椎椎间融合术治疗连续双节段腰椎退行性疾病[J].脊柱外科杂志,2022,20(4):217-222. |
微创经椎间孔入路腰椎椎间融合术治疗连续双节段腰椎退行性疾病  点此下载全文 (Fulltext) |
| 胡巍然 宋月鹏 施新革 马浩浩 王红强 邵佳 张锴 高延征* |
| 河南省人民医院脊柱脊髓外科, 郑州 450003 |
| 基金项目：河南省自然科学基金青年项目(202300410400)河南省医学科技攻关计划联合共建项目(LHGJ20200047)河南省医学科技攻关计划省部共建项目(SB201901085) |
| DOI：10.3969/j.issn.1672-2957.2022.04.001 |
| 摘要点击次数: 625 |
| 全文下载次数: 261 |
| 摘要： |
| 目的比较微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)及传统开放TLIF治疗双节段腰椎退行性疾病的临床疗效。方法 2015年1月-2019年9月收治双节段腰椎退行性疾病患者56例,采用MIS-TLIF治疗26例(MIS-TLIF组)、采用传统开放TLIF治疗30例(TLIF组)。记录2组手术时间、术中透视次数、术中出血量、术后引流量、术后卧床时间、术后肌酸激酶(CK)等指标及并发症发生情况。术前及术后1周、3个月、12个月时采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估腰腿痛程度及腰椎功能。采用Bridwell分级评估术后椎间融合情况。在术后腰椎CT上采用Rao分级评价螺钉位置。结果所有手术顺利完成,所有患者随访(14.7±2.1)个月。MIS-TLIF组较TLIF组手术时间长,术中透视次数多,但术后卧床时间短,差异均有统计学意义(P < 0.05);2组术中出血量、术后引流量及术后CK水平差异无统计学意义(P > 0.05)。2组术后各时间点腰腿痛VAS评分及ODI较术前均显著改善,差异有统计学意义(P < 0.05);MIS-TLIF组术后1周腰痛VAS评分较TLIF组更低,差异有统计学意义(P < 0.05),2组术后3、12个月时腰腿痛VAS评分差异无统计学意义(P > 0.05);各随访时间点2组ODI差异无统计学意义(P > 0.05)。2组患者均未发生内固定松动或融合器移位等并发症。2组椎间融合率组间差异无统计学意义(P > 0.05)。2组A型螺钉分布差异无统计学意义(P > 0.05),B型螺钉分布差异有统计学意义(P < 0.05)。术后共发生硬膜撕裂4例、下肢麻木加重4例、切口愈合不良1例,2组并发症发生率差异无统计学意义(P > 0.05)。结论 MIS-TLIF与传统开放TLIF临床疗效类似,且在手术时间、术中辐射暴露情况及椎旁肌肉损伤等方面并无明显优势,双节段腰椎退行性疾病患者建议选择传统开放TLIF治疗。 |
| 关键词：腰椎 椎间盘退行性变 脊柱融合术 外科手术,微创性 内固定器 |
| Minimally invasive transforaminal lumbar interbody fusion for treatment of continuous double-segment lumbar degenerative disease Fulltext |
| Hu Weiran Song Yuepeng Shi Xinge Ma Haohao Wang Hongqiang Shao Jia Zhang Kai Gao Yanzheng* |
| Department of Spinal and Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, Henan, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional TLIF in the treatment of double-segment lumbar degenerative diseases.Methods The clinical data of 56 patients with double-segment lumbar degenerative disease from January 2015 to September 2019 were retrospectively analyzed,including 26 cases treated with MIS-TLIF (MIS-TLIF group) and 30 cases treated with traditional open TLIF (TLIF group).Operation time,intraoperative fluoroscopy frequency,intraoperative blood loss,postoperative drainage volume,postoperative in bed time,postoperative creatine kinase (CK) level and complications were recorded.The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate low back pain,leg pain and lumbar function at postoperative 1 week,3 months and 12 months.Bridwell grading was used to evaluate postoperative interbody fusion.The screw position was evaluated by Rao grading on postoperative CT.Results All the operations were completed successfully,and patients were follow-up for 14.7±2.1 months.Compared with the TLIF group,the MIS-TLIF group had longer operation time,more intraoperative fluoroscopy frequency,but shorter postoperative in bed time,all with a statistical significance (P < 0.05).The VAS score of low back and leg pain and ODI at all postoperative time points in both groups were significantly improved compared with those before surgery,all with a statistical significance (P < 0.05);the low back pain VAS score of MIS-TLIF group was lower than that of TLIF group at postoperative 1 week (P < 0.05),and there was no significant difference in low back and leg pain VAS scores of the 2 groups at postoperative 3 and 12 months (P > 0.05).There was no significant difference in ODI between the 2 groups at each follow-up time point (P > 0.05).No complications such as internal fixation loosening or fusion device displacement occurred in the 2 groups.There was no significant difference in the interbody fusion rate between the 2 groups (P > 0.05).There was no significant difference in type A screw distribution between the 2 groups (P > 0.05),but there was a significance difference in type B screw distribution between the 2 groups (P < 0.05).Postoperative dural tear occurred in 4 cases,lower limb numbness increased in 4,and wound healing was poor in 1.There was no significant difference in the incidence of complications between the 2 groups (P > 0.05).Conclusions MIS-TLIF has similar clinical efficacy to traditional TLIF,but has no obvious advantages in terms of operation time,intraoperative radiation exposure and paravertebral muscle injury.Patients with double-segment lumbar degenerative diseases are advised to choose traditional TLIF for surgical treatment. |
| Keywords:Lumbar vertebrae Intervertebral disc degeneration Spine fusion Surgical procedures,minimally invasive Internal fixators |
|
|
HTML
查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
|
|
