| 徐国康,苏棋,屠玉兰,罗金伟,陈飞.经椎间孔腰椎体间融合术的微创技术改良[J].浙江中西医结合杂志,2017,27(3): |
| 经椎间孔腰椎体间融合术的微创技术改良 |
| Research of Modified Minimal Invasive Skills for Transforaminal Lumbar Interbody Fusion Xu Guokang , Tu Yulan , Su Qi et al. Department of Orthopedics,The First People’s Hospital of Fuyang ,Hangzhou311400,China |
| 投稿时间：2016-08-18 修订日期：2016-10-10 |
| DOI： |
| 中文关键词: 经椎间孔椎体间融合术 微创 肌间隙 入路 |
| 英文关键词:Minimal invasive Transforminal lumbar interbody fusion Muscle space Approach |
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| 中文摘要: |
| 【】 目的: 探讨采用一个切口单侧减压加对侧肌间隙入路的微创经椎间孔椎体间融合术(Mis-TLIF)治疗下腰椎疾患的临床疗效 方法: 自2010年5月至2015年3月,89例下腰椎退变疾病患者接受TLIF手术,53 例采用单侧减压加对侧肌间隙入路方法(Mis-TILF),其中男24 例,女 29 例,年龄41～77 岁,平均 56.3±10.1 岁；36例采用传统开放手术方法(Con-TLIF),其中男16 例,女20 例,年龄39～69 岁,平均55.7±11.3 岁。分析比较两组手术时间、术中出血量、术中术后并发症、术前和术后1天肌酸激酶值、术前和末次随访时疼痛视觉模拟评分(visual analogue scale, VAS)及Oswestry 功能障碍指数(Oswestry disability index, ODI),采用 X线及 CT 三维重建比较两组末次随访时椎间植骨融合率。结果：89例患者均顺利完成手术并获得随访,随访时间4~45个月,平均15.7个月。Mis-TLIF组平均手术时间和术中出血量分别为131.5±21.0 min、330.6±57.6 ml；Con-TLIF组为150.3±30.3 min、450.1±116.4 ml,Mis-TLIF组显著优于Con-TLIF组(P＜0.05)。 并发症方面, Mis-TLIF组术中硬膜破裂2例,术后切口感染1例,并发症发生率0.06%(3/53),切口感染率0.02% (1/53)；Con-TLIF组术中硬膜破裂1例,神经根损伤1例,术后切口感染4例,融合器移位1例,内固定螺丝松动1例,术后并发症发生率22.2%(8/36),感染率11.1%(4/36),Mis-TLIF组显著优于Con-TLIF组(P＜0.05)。但两组在术前和术后1天CPK值、术前和末次随访VAS评分及ODI评分方面差异均无统计学意义(P＞0.05)。末次随访时行X线及CT 三维重建判定椎间融合率,Mis-TLIF 组椎间融合率100%(53/53),Con- TLIF 组椎间融合率为97.2%(35/36),两组间无统计学差异(P＞0.05)。 结论：应用单侧减压加对侧肌间隙入路的改良TLIF手术治疗腰椎退变性疾病,具有微创、出血少、手术时间短、并发症低、医患辐射少、无需特殊器械等优点,是一种安全有效的微创术式。 |
| 英文摘要: |
| Objective: To evaluate the clinical outcomes of minimal invasive transforaminal lumbar interbody fusion using unilateral decompression combined with contralateral muscle space approach by one incision. Method：From May 2010 to March 2015，89 patients with degenerative low lumbar disease were treated with transforaminal lumbar interbody fusion and divided into two groups. Among them, 53 cases received unilateral decompression combined with contralateral muscle space approach （Mis-TILF）by one incision, there were 24 males and 29 females, with a mean age of 56.3±10.1 years(range from 41 to 77 years); 36 cases received conventional open approach（Con-TLIF）, 16 males, 20 females, with a mean age of 55.7±11.3 years (range from 39 to 69). The data including operation time, intraoperative blood loss, operative complications, CPK of pre-operation and one day post-operation, VAS scores and ODI of pre-operation and last visit were compared between two groups. Furthermore, X -ray and three -dimensional computed tomography were used to evaluate the fusion rate of last visit. Results：All 89 patients were successfully operated and received follow-up from 4 to 45 months with an average of 15.7 months．The mean operation time, mean intraoperative blood loss in Mis-TILF group were （131.5±21.0）min, (330.6±57.6)ml respectively; and (150.3±30.3)min , （450.1±116.4）ml respectively in Con-TLIF group. Mis-TLIF group had less operation time and blood loss than Con-TLIF (t =3.460, P = 0. 001; t = 6.417, P = 0.000). Complications were noted in 3 patients in Mis-TILF group, including 2 dura tearing and 1 incision infection, the total incidence rate of complications was 0.06% (3/53), infection rate was 0.02% (1/53); Various complications were noted in 8 patients in Con-TLIF group, including 1 dura tearing, 1 nerve root injury, 4 incision infection, 1 inter-vertebral cage shifting, 1 inter fixation failure, the total incidence rate of complications was 22.2% (4/36), infection rate was 11.1% (4/36), Mis-TLIF group was significantly superior than Con-TLIF group (P＜0.05). But there were no significant differences between two groups in CPK of pre-operation and one day post-operation, VAS scores and ODI of pre-operation and last visit（P＞0.05）. X -ray and three –dimensional computed tomography were performed at the last visit. Graft fusion rate in MIS-TLIF group was 100% (53/53) , and 97.2% (35/36) in Con- TLIF group. there was no significant difference between two groups(P＞0.05). Conclusions: Applying one incision and unilateral decompression combined with contralateral muscle space approach in TLIF for treatment of lumbar degenerative disease is a safe, effective and minimal invasive operation method. It has advantages of little trauma, less complication, lower bleeding, shorter operation time, lower times of X-ray radiation and no use of special implement etc. |
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