摘要
目的探讨显微镜辅助下微创经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性疾病的疗效。方法回顾分析2010年1月-2011年6月采用显微镜辅助下微创TLIF治疗的82例腰椎退行性疾病患者(微创组)临床资料,与同期行传统开放TLIF治疗的76例患者(传统组)进行比较。两组患者性别、年龄、病程、病变类型、病变节段、术前Oswestry功能障碍指数(ODI)及疼痛视觉模拟评分(VAS)比较,差异均无统计学意义(P>0.05),具有可比性。比较两组患者围手术期相关参数及影像学、临床疗效评定结果。结果两组手术时间和术中放射线暴露时间比较,差异均无统计学意义(P>0.05);但微创组术中出血量、术后引流量均显著低于传统组(P<0.05)。术中传统组2例出现硬膜撕裂;术后两组各1例发生切口浅表感染,其余患者切口均Ⅰ期愈合。两组患者均获随访,随访时间12～28个月,平均18个月。X线片示均无内固定物断裂及松动等并发症发生。末次随访时,微创组和传统组植骨融合率分别为95.1%(78/82)和96.1%(73/76),比较差异无统计学意义(χ2=0.012 2,P=0.912 0)。两组术后各时间点ODI均较术前显著改善(P<0.05);微创组术后3个月时ODI显著优于传统组(t=—11.941 1,P=0.000 0),但术后1年及末次随访时两组差异无统计学意义(P>0.05)。两组术后各时间点VAS评分与术前比较,差异均有统计学意义(P<0.05);微创组术后1 d及3个月时VAS评分显著低于传统组(P<0.05),但术后1年及末次随访时两组差异无统计学意义(P>0.05)。结论显微镜辅助下微创TLIF治疗腰椎退行性疾病安全可靠、创伤小、出血少、术后疼痛轻,近期疗效与传统开放TLIF相当。
Objective To investigate the effectiveness of minimally invaslve transtorammal lumbar lnterDoay fusion （TLIF） assisted with microscope for lumbar degenerative disease. Methods Retrospective analysis was made on the clinical data of 82 patients with lumbar degenerative disease （minimally invasive group） undergoing minimally invasive TLIF assisted with microscope between January 2010 and June 2011, which was traditional open TLIF. There was no significant difference in compared with those of 76 patients （traditional group） undergoing age, gender, disease duration, disease type, lesion level, preoperative visual analogue scale （VAS）, and preoperative Oswestry disability index （ODI） between 2 groups （P 〉 0.05）. The perioperative related parameters, radiography index, and effectiveness were documented and compared. Results There was no significant difference in operation time and intraoperative radiological exposure time between 2 groups （P 〉 0.05）, but intraoperative blood loss and postoperative drainage volume in the minimally invasive group were significantly less than those in the traditional group （P 〈 0.05）. Dural tear occurred in 2 patients of the traditional group. Superficial infection of incision occurred in 1 case in each group, respectively; and primary healing of incision was obtained in the other patients. All patients were followed up 12- 28 months （mean, 18 months）. No failure of internal fixation occurred. Radiological analysis showed that the bone graft fusion rate was 96.1O/o （73/76） in the traditional group and 95.1% （78/82） in the minimally invasive group at last follow-up, showing no significant difference （X2= 0.012 2, P= 0.912 0）. The postoperative ODI and VAS score were significandy improved when compared with preoperative ones in 2 groups （P 〈 0.05）; the ODI of the minimally invasive group were significantly better than those of the traditional group at 3 months （t= -11.941 1, P=0.000 0）, and the VAS score of the minimally invasive group was significantly lower than that of the traditional group at 1 day and 3 months （P 〈 0.05）; but no significant difference was found in ODI and VAS score between 2 groups at 1 year and last follow-up （P 〉 0.05）. Conclusion Minimally invasive TLIF is an effective methodto treat lumbar degenerative disease. This procedure is safe and reliable because it has less injury, less blood loss, and milder pain than the traditional open TLIF, and the short-term effectiveness is comparable in 2 procedures.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第3期268-273,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
腰椎退行性疾病
经椎间孔腰椎椎间融合术
微创手术
Lumbar degenerative disease Transforaminal lumbar interbody fusion Minimally invasivesurgery
