摘要
目的:比较前路腰椎椎体间融合术(anterior lumbar interbody fusion,ALIF)和经椎间孔入路腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎术后综合征的效果。方法:2005年3月～2007年3月收治31例腰椎术后综合征患者,其中14例行ALIF,17例行TLIF,观察两组患者手术前后Oswestry功能障碍指数(ODI)、模拟疼痛评分(VAS)、椎体间高度、椎体间角度,比较两组患者疗效、融合情况和并发症。结果:ALIF组手术时间平均为110min,术中出血量平均为210ml,TLIF组分别为160min、620ml,两组比较有显著性差异(P<0.05)。ALIF组出现2例腹膜撕裂,予缝合后愈合;3例发生腹膜后血肿、麻痹性肠梗阻,经保守治疗完全恢复正常。TLIF组出现2例硬膜撕裂,予缝合后愈合;2例神经根牵拉伤,经脱水、非甾体类消炎止痛药物治疗完全恢复正常。随访12～24个月,平均18个月,每组术后1年时ODI和VAS均较术前明显减少(P<0.01),椎间高度、角度均明显增加(P<0.05);两组间术前及术后1年ODI、VAS、椎间高度、椎间角度无明显差异(P>0.05);ALIF组疗效优良率为85.7%,TLIF组为82.4%,两组之间无显著性差异(P>0.05);两组椎间融合率均为100%。结论:ALIF和TLIF治疗腰椎术后综合征均可达到满意的椎间融合率和临床效果,ALIF手术时间相对较短、出血量相对较少。
Objective：To compare the effect and complications of anterior lumbar interbody fusion （ALIF） technique with transforaminal lumbar interbody fusion（TLIF） technique for the treatment of failed back surgery syndrome.Method：The medical records and radiographs of 14 patients undergoing ALIF and 17 patients undergoing TLIF between March 2005 and March 2007 were retrospectively reviewed.The preoperative and 1 year postoperative functional evaluation were graded by using the Oswestry disability index（ODI） and the visual analog scale（VAS）.The height and angle of the intervertebral space and the fusion status were measured as well.Result：The operation time averaged 110min for ALIF and 160min for TLIF,and the average blood loss was 210ml for ALIF and 620ml for TLIF,which showed ALIF＇s superior role over TLIF in its capacity to decrease the operation time and blood loss （P〈0.05 ）.There were 2 cases with dural sac tear and 2 cases with nerve root impingement in TLIF and 2 cases with peritoneum tear and 3 cases with functional ileus in ALIF. 2 cases with dural sac tear in TLIF and 2 cases with peritoneum tear in ALIF were sutured during operating and healed.2 cases with nerve root impingement in TLIF and 3 cases with functional ileus in ALIF recovered well.All cases were followed up and the average follow-up time was 18 mouths.The pain relief in the VAS and the reduction of the ODI was significant （P〈0.01） and the height and angle of the intervertebral space increased significantly（P〈0.05） at 1 year after operation.No significant difference in ODI,VAS and the height and angle of the intervertebral space were found between ALIF and TLIF at preoperation or 1 year after operation（P〉0.05）.Excellent and good resuh were achieved in 85.7% patients for ALIF and 82.4% for TLIF（P〉0.05）.The fusion rate was 100% for both ALIF and TLIF.Conclusion：Both ALIF and TLIF could achieve sat isfactory clinical and radiographic results for the failed back surgery syndrome.ALIF has the advantages of less operation time and less blood loss than TLIF.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第11期832-837,共6页
Chinese Journal of Spine and Spinal Cord
关键词
腰椎术后综合征
前路
经椎间孔入路
椎体间融合术
Failed back surgery syndrome
Anterior
Transforaminal
Lumbar interbody fusion
