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裘剑如,焦宇澄,郑建城,吴文坚,梁裕*.微创经椎间孔入路腰椎椎间融合术治疗单节段腰椎退行性疾病对椎旁肌的影响[J].脊柱外科杂志,2022,20(5):295-301.
微创经椎间孔入路腰椎椎间融合术治疗单节段腰椎退行性疾病对椎旁肌的影响     点此下载全文 (Fulltext)
裘剑如  焦宇澄  郑建城  吴文坚  梁裕*
上海交通大学医学院附属瑞金医院骨科, 上海 200025
基金项目:
DOI:10.3969/j.issn.1672-2957.2022.05.002
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摘要:
      目的 对比微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)与传统开放TLIF治疗单节段腰椎退行性疾病的临床疗效及椎旁肌损伤变化。方法 2017年1月—2020年1月收治单节段腰椎退行性疾病患者41例,其中18例采用MIS-TLIF治疗(MIS-TLIF组),23例采用TLIF治疗(对照组)。记录2组患者卧床时间、住院时间,术前和术后1、3、5 d血清肌酸激酶(CK)、白介素-6(IL-6)水平;术前及术后6、12个月采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估患者腰腿痛程度和腰椎功能状况。在术前、术后12个月MRI上测量手术节段及邻近节段多裂肌横截面积(MCSA),并计算其变化率。结果 所有手术顺利完成,患者随访(12.40±0.35)个月。MIS-TLIF组术后卧床时间、住院时间均短于对照组,差异有统计学意义(P < 0.05)。2组CK、IL-6血清浓度在术后呈显著升高趋势,其峰值均出现在术后1 d,术后3、5 d逐渐下降;MIS-TLIF组术后1 d的CK、IL-6血清浓度显著低于对照组,差异有统计学意义(P < 0.05)。2组术后6、12个月的VAS评分、ODI较术前显著改善,MIS-TLIF组术后6个月的ODI较对照组更低,差异均有统计学意义(P < 0.05)。2组中各10例患者末次随访时复查腰椎MRI,MIS-TLIF组术后12个月责任节段MCSA显著大于对照组,MCSA减少率显著低于对照组,差异均有统计学意义(P < 0.05)。而MIS-TLIF组术后12个月邻近节段MCSA与对照组相比,差异无统计学意义(P > 0.05);但邻近节段MCSA减少率显著低于对照组,差异有统计学意义(P < 0.05)。结论 MIS-TLIF较传统开放手术具有切口小、组织损伤少、功能康复快等特点,且在术后早期患者全身炎性反应更轻,术后中期对多裂肌的干扰更小。
关键词:腰椎  椎间盘退行性变  肌萎缩  脊柱融合术  外科手术  微创性
Effect of minimally invasive transforaminal lumbar interbody fusion on paravertebral muscles in treatment of single level lumbar degenerative diseases    Fulltext
Qiu Jianru  Jiao Yucheng  Zheng Jiancheng  Wu Wenjian  Liang Yu*
Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Fund Project:
Abstract:
      Objective To compare the clinical efficacy and changes of paraspinal muscle injury of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) and traditional TLIF in the treatment of single level lumbar degenerative diseases.Methods From January 2017 to January 2020,41 patients with single level lumbar degenerative diseases were treated,of which 18 patients were treated with MIS-TLIF(MIS-TLIF group) and 23 patients with TLIF(control group).The bed rest time and hospital stay were recorded;the changes of serum creatine kinase(CK) and interleukin-6(IL-6) levels before operation and at 1,3,and 5 d after operation were analyzed.The visual analogue scale(VAS) score and Oswestry disability index(ODI) were used to evaluate low back and leg pain and lumbar function before operation and at 6,12 months after operation.The multifidus cross-sectional area(MCSA) of the operated and adjacent segments were measured on MRIs before and 12 months after operation,and the change rate was calculated.Results All the operations were completed successfully,and the patients were follow-up for (12.40±0.35) months.The postoperative bed rest time and hospital stay in MIS-TLIF group were shorter than those in the control group,and the differences were statistically significant(P < 0.05).The serum concentrations of CK and IL-6 in the 2 groups showed a significantly increased trend after operation,and their peaks appeared at postoperative 1 d and gradually decreased at postoperative 3 and 5 d.The serum levels of CK and IL-6 inMIS-TLIF group were significantly lower than those in the control group at postoperative 1 d,and the differences were statistically significant(P < 0.05).The VAS score and ODI of the 2 groups at postoperative 6 and 12 months were significantly improved compared with those before operation,and ODI of MIS-TLIF group at postoperative 6 months was lower than that of the control group,all with a statistically significant difference(P < 0.05).Lumbar MRI of 10 patients in each group was reviewed at the final follow-up;and MCSA at operated segment in MIS-TLIF group was significantly higher than that in the control group,and the MCSA change rate at operated segment was significantly lower than that in the control group,all with a statistical difference(P < 0.05).There was no significant difference in MCSA at adjacent segments between the 2 groups at the final follow-up(P > 0.05),however,the MCSA change rate at adjacent segments in MIS-TLIF group was significantly lower than that in the control group,and the difference was statistically significant(P < 0.05).Conclusion Compared with traditional open TLIF,MIS-TLIF has the characteristics of smaller incision,less tissue damage,faster functional recovery,and lighter systemic inflammatory response in the early postoperative period,and less interference to the multifidus muscle in the middle postoperative period.
Keywords:Lumbar vertebrae  Intervertebral disc degeneration  Muscular atrophy  Spine fusion  Surgical procedures  minimally invasive
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