摘要
[目的]探讨经椎旁肌间隙手术入路在L5S1单节段腰椎间盘突出症患者腰椎融合手术中的应用价值。[方法]自2011年16月,对32例L5S1单节段腰椎间盘突症患者进行经椎间孔减压椎间植骨融合手术(transforaminallumbar interbody fusion,TLIF),其中采用经椎旁肌间隙手术入路15例(A组),采用后正中入路17例(B组)。统计分析两组患者手术时间、术中出血量、术后引流量、VAS评分、术后卧床时间及手术并发症的差异。[结果]A组手术时间(104.80±12.60)min、术中出血(134.00±33.55)ml、术后引流量(92.73±13.23)ml,术后VAS评分(1.93±0.59)分、术后卧床时间(2.60±0.38)d,切口愈合不良2例,无其他并发症,术后并发症发生率为13.3%。B组手术时间(129.18±33.88)min、术中出血(188.53±57.98)ml、术后引流量(125.00±53.29)ml、术后VAS评分(3.17±0.88)分、术后卧床时间(4.03±0.69)d,硬膜损伤致脑脊液漏1例,切口愈合不良2例,无其他并发症,术后并发症发生率为17.6%。两组患者手术时间、术中出血量、术后引流量、术后VAS评分及卧床时间均有显著差异(P<0.05),A组明显优于B组;两组患者术后并发症无显著差异(P>0.05)。[结论]采用经椎旁肌间隙入路行经椎间孔减压椎间植骨融合手术治疗L5S1单节段腰椎间盘突出症有助于术中减少手术创伤、保护椎旁肌及准确置入内固定物,是一种微创、便捷、安全的手术入路。
[ Objective ] To evaluate the clinical efficacy of paraspinal intermuscular approach on treatment of L5 S1 single - level lumbar disc herniation. [ Methods] Clinical material of 32 patients who had lumbar disc herniation surgery using transfo- raminal lumbar interbody fusion （TLIF） in L5 S1 level was collected from January 2011 to June 2011. Study group comprised 15 patients who received operations with paraspinal intermuscular approach. Control group included 17 patients who received opera- tions with conventional posterior approach. Operative duration, blood loss, drainage, postoperative VAS scores, postoperative duration in bed and postoperative complication rate were compared separately by statistical analysis. [ Results ] In study group receiving operations with paraspinal intermuscular approach, the average operative duration was （104. 80 ±12. 60） rain; the av- erage blood loss was （ 134.00±33.55 ） ml; the average drainage was （92. 73 ± 13.23 ） ml; the average postoperative VAS score was （ 1.93 ±0. 59） ; and the average postoperative duration in bed was （2. 60 ±0. 38） d; incision poor healing was found in 2 patients; complication rate was 13.3%. In control group receiving operations with conventional posterior approach, the av- erage operative duration was （129. 18 ± 33.88） min; the average blood loss was （188.53 ± 57.98） ml; the average drainage was （125.00± 53.29） ml; the average postoperative VAS score was （3.17 ± 0. 88） ; and the average postoperative duration in bed was （4. 03 ± 0. 69） d; incision poor healing and cerebrospinal fluid leakage were found in 2 patients and 1 patient respec- tively; complication rate was 17.6%. In terms of the average operative duration, the average blood loss, the average drainage,the average postoperative VAS scores and postoperative duration in bed, significant differences were analyzed between two groups （P 〈 0. 05 ）, where study group showed better efficacy than control group. By contrast, no significant difference was found in postop- erative complication rate （ P 〉 0. 05 ） . [ Conclusion ] Paraspi-nal intermuscular approach on treatment of single - level lumbar disc herniation in L5 S1 helps reduce the invasive, protect pa- raspinal muscle and fix the pedicle screws, which is regarded as an accurate, minimally invasive and safe option.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第9期874-878,共5页
Orthopedic Journal of China
关键词
经椎旁肌间隙入路
腰椎融合术
腰椎间盘突出症
L5S1
paraspinal intermuscular approach, lumbar interbody fusion, lumbar disc herniation, L5 S1
