| 刘飞俊.Wiltse入路改良经椎间孔腰椎间融合术治疗复发性腰椎间盘突出症[J].浙江中西医结合杂志,2016,26(7): |
| Wiltse入路改良经椎间孔腰椎间融合术治疗复发性腰椎间盘突出症 |
| Operative treatment of recurrent lumbar disc herniation with modified transforaminal lumbar interbody fusion through Wiltse approach |
| 投稿时间：2016-02-22 修订日期：2016-03-28 |
| DOI： |
| 中文关键词: 复发性椎间盘突出，Wiltse，椎间融合术 |
| 英文关键词:recurrent lumbar disc herniation Wiltse lumbar interbody fusion |
| 基金项目:浙江丽水市科技计划项目2012JYZB92 |
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| 中文摘要: |
| 【】 目的 观察Wiltse入路改良经椎间孔腰椎间融合术治疗复发性腰椎间盘突出症临床疗效。方法 选取2011年6月至2013年12月在我院治疗的复发性腰椎间盘突出症患者21例,其中男性14例,女性7例,年龄45～76岁,平均52.5岁；均行Wiltse入路改良经椎间孔腰椎间融合手术治疗,随访18月以上,评估患者围手术期指标、术前1天、术后2周、3个月及末次随访的腰痛VAS评分、下肢痛VAS评分和Oswestry功能障碍指数(Oswestry disability index,ODI)。结果 所有患者随访18-36个月,平均随访时间(21.3±2. 4)个月,无感染及内固定失败发生,手术时间(122.38±21.13 ) min,术中失血量和术后引流量分别是(252.38±94.17)、(90.45±25.57)ml,2例发生脑脊液漏,4例残留下肢麻木,但无肌力下降表现。术后2周、3月、末次随访腰背痛VAS评分分别为(3.14±0.79)、(2.24±0.76)、(1.90±0.94)；下肢痛VAS评分分别为(2.80±0.60)、(2.28±0.84)、(0.95±1.17),术后3月及末次随访ODI分别为：(20.4±7.6)%、(16.5±6.3)%,与术前1天相比均明显改善,差异有统计学意义；末次随访复查腰椎CT,椎间植骨融合优良率(95.2%)。结论 Wiltse入路改良TLIF可治疗复发性腰椎间盘突出症。具有手术入路安全,手术时间短,出血少,腰腿疼痛康复快,能避免再次侧方牵拉、剥离多裂肌,是符合微创理念的适合腰椎大多数翻修手术入路选择。 |
| 英文摘要: |
| [Abstract] Objective To investigate the clinical results of modified transforaminal lumbar interbody fusion through Wiltse approach for the treatment of recurrent lumbar disc herniation. Methods Clinical data of 21 cases of recurrent lumbar disc herniation in our department from June 2011 to December 2013 were retrospectively analyzed 14 male and 7 female patients with the age from 45 to 76 years with an average of 52.5 years were treated with modified transforaminal lumbar interbody fusion through Wiltse approach and were followed up with more than 18 months．The results of perioperative parameters, radiographic images, back pain VAS, leg pain VAS and ODI scores between preoperative 1 day, postoperative 2 weeks, postoperative 3 months and last follow-up were assessed. Results All the cases were followed up from 18 to 36 months with an average of 21.3±2.4 months. There is no infection and implant failure,The average operative time was (122.38±21.13)minutes, the average operative blood loss and postoperative drainage was respectively (252.38±94.17)ml and (90.45±25.57)ml, 2 cases of cerebrospinal fluid leakage 4 cases of residual lower extremity numbness, but no muscle loss. Low back pain VAS scores was respectively (3.14±0.79), (2.24±0.76), (1.90 ± 0.94), and leg pain VAS scores was (2.80±0.60), (2.28±0.84), (0.95±1.17) of postoperative 2 weeks, postoperative 3 months and last follow-up. ODI of postoperative 3 months and last follow-up was (20.4±7.6)%, (16.5±6.3)%.To compare preoperative 1 day, the significant improvement of VAS and ODI could be found, and the difference was statistically significant. Conclusion Recurrent lumbar disc herniation could be treated with modified transforaminal lumbar interbody fusion through Wiltse approach. and the advantage including surgical approach safety, shorter operative time, less bleeding, leg pain rapid recovery, to avoid the side pulled and stripped multifidus muscle again.it is a therapeutic method for most revision surgery of lumbar approach selection consistent with the concept of minimally invasive. |
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