摘要
目的总结扩张通道下小切口经椎间孔神经管减压椎间融合(minimally invasive transforaminal lumbarinterbody fusion,MI-TLIF)辅以椎弓根螺钉内固定治疗退变性腰椎侧弯性椎管狭窄的临床疗效。方法 2009年4月-2010年10月,采用扩张通道下MI-TLIF辅以椎弓根螺钉内固定治疗退变性腰椎侧弯性椎管狭窄患者20例(A组),与同期行传统后路开放减压椎间融合椎弓根螺钉内固定方法治疗的19例(B组)进行疗效比较。两组患者性别、年龄、病程、腰椎退变性侧弯范围及术前腰痛和腿痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、Cobb角等一般资料比较差异均无统计学意义(P>0.05),具有可比性。比较两组患者手术时间、术中出血量、术后自主翻身时间、术后并发症发生率、植骨融合率、Cobb角、ODI评分及腰、腿痛VAS评分等指标。结果 A组手术时间显著长于B组,术中出血量显著少于B组,差异均有统计学意义(P<0.05);术后自主翻身时间两组比较差异无统计学意义(t=1.869,P=0.069)。A、B组并发症发生率分别为20.0%(4/20)和26.3%(5/19),比较差异无统计学意义(χ2=0.219,P=0.640)。39例均获随访,随访时间2年～3年6个月,平均2.9年。末次随访时A、B组植骨融合率分别为92.9%(78/84)和95.2%(80/84),比较差异无统计学意义(χ2=0.425,P=0.514)。根据Macnab标准评定疗效,A组获优12例,良6例,可1例,差1例,优良率90.0%;B组获优12例,良5例,可2例,优良率89.5%;两组比较差异无统计学意义(Z=—0.258,P=0.835)。两组术后腰、腿痛VAS评分、ODI评分及Cobb角均较术前显著改善,差异有统计学意义(P<0.05);术后2周及末次随访时两组间各指标比较差异均无统计学意义(P>0.05)。结论扩张通道下MI-TLIF辅以椎弓根螺钉内固定术可用于治疗退变性腰椎侧弯性椎管狭窄,临床疗效与传统后路开放减压椎间融合椎弓根螺钉内固定术相似,且术中出血少,对组织损伤小。
Objective To explore the effectiveness of minimally invasive transforaminal lumbar interbody fusion （MI- TLIF） for degenerative lumbar scoliosis stenosis by expandable tubular retractor. Methods Between April 2009 and October 2010, 39 patients with degenerative lumbar scoliosis stenosis were treated. Of 39 patients, 20 underwent MI-TLIF （group A） and 19 underwent open surgery （group B）. There was no significant differences in gender, age, disease duration, range of lumbar degenerative scoliosis, Cobb angle, Oswestry disability index （ODI）, and visual analogue scale （VAS） between 2 groups （P 〉 0.05）. The operation time, intraoperative blood loss, postoperative independently turning over time, postoperative complication rate, Cobb angle, fusion rates, ODI score, and VAS score were compared between 2 groups. Results The operation time of group A was significantly longer than that of group B （P 〈 0.05）, and the intraoperative blood loss of group A was significantly less than that of group B （P 〈 0.05）; no significant difference was found in postoperative independently turning over time between 2 groups （t=1.869, P=0.069）. The complication rate was 20.0% （4/20） in group A and 26.3% （5/19） in group B, showing no significant difference （Z2=0.219,P=0.640）. All patients were followed up 2 years to 3 years and 6 months （mean, 2.9 years）. At last follow-up, the fusion rate of bone graft was 92.9% （78/84） in group A and 95.2% （80/84） in group B, showing no significant difference （g~=0.425, P=0.514）. According to the Macnab standard for effectiveness evaluation, the results were excellent in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 90.0% in group A; the results were excellent in 12 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 89.5% in group B; there was no significant difference between 2 groups （Z= --0.258, P=0.835）. The postoperative VAS score, OD! score, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups （P 〈 0.05）; and there was no significant differencesbetween 2 groups at 2 weeks after operation and last follow-up （P 〉 0.05）. Conclusion MI-TLIF by expandable tubular retractor is an available clinical choice in treating degenerative lumbar scoliosis stenosis. It can obtain the same effectiveness as the open surgery.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第4期404-408,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
退变性腰椎侧弯
椎管狭窄
腰椎融合
微创手术
Degenerative lumbar scoliosis Spinal stenosis Lumbar fusion Minimally invasive surgery
