| 曾顺福,王 建,陆 炎,刘 杰.单节段微创经椎间孔腰椎椎体间融合内固定治疗腰椎滑脱症的效果[J].中国脊柱脊髓杂志,2011,(5):399-403. |
| 单节段微创经椎间孔腰椎椎体间融合内固定治疗腰椎滑脱症的效果 |
| 中文关键词: 腰椎滑脱症 微创外科 经椎间孔腰椎间融合术 内固定 |
| 中文摘要: |
| 【摘要】 目的：评价单节段微创经椎间孔腰椎椎体间融合（minimally invasive transforaminal lumbar interbody fusion，MiTLIF）内固定治疗腰椎滑脱症的临床效果。方法：2007年1月~2010年3月163例腰椎滑脱症患者接受单节段MiTLIF和内固定治疗。男61例，女102例；年龄37～72岁，平均51.6岁。退变性腰椎滑脱97例，峡部裂性腰椎滑脱66例；Ⅰ度滑脱135例，Ⅱ度28例；L3滑脱7例，L4 86例，L5 70例。采用经最长肌和多裂肌间隙入路，可扩张工作通道置于关节突上，行MiTLIF和经皮椎弓根螺钉固定。将163例患者按时间顺序依次分为A组（第1~55例）、B组（第56~110例）和C组（第111~163例），统计手术时间、术中X线暴露时间、术中和术后出血量及并发症发生情况，并进行组间比较。采用腰痛视觉模拟评分（VAS）和功能障碍指数（ODI）评分评估临床效果，腰椎薄层CT扫描重建评价椎间融合情况。结果：163例术中出血100～750ml，平均330ml；术后出血10～175ml，平均57ml；手术时间83～230min，平均145min；术中X线暴露时间27～126s，平均59s。B组术中出血量和X线暴露时间与A组比较及C组手术时间、X线暴露时间、术中和术后出血量与A组比较均明显减少（P<0.05）；C组手术时间、术中X线暴露时间、术中和术后出血量与B组比较亦明显减少（P<0.05）。7例术中硬膜囊撕裂，其中A组4例，B组2例，C组1例，均在术后第2天出现脑脊液漏，经对症处理术后5d内脑脊液漏停止。4例术后出现新的神经根损害表现，均为A组病例，通过内窥镜下减压和神经根松解后神经根损害症状消失。91例患者获得10～47个月随访，平均24.5个月。术前、术后3d及末次随访腰痛VAS评分分别为6.8±2.4分、1.5±0.6分和0.8±0.4分，术后3d及末次随访与术前比较有显著性差异（P<0.05）。术前及末次随访ODI评分分别为39.4±5.1分和11.3±2.6分，差异有显著性（P<0.05）。末次随访椎间融合率为96.7%（88/91）。结论：采用单节段MiTLIF和经皮椎弓根螺钉固定治疗Ⅰ度、Ⅱ度腰椎滑脱症安全有效。 |
Clinical outcome of single-level minimally invasive transforaminal lumbar interbody fusion for lumbar spine spondylolisthesis |
| 英文关键词:Lumbar spondylolisthesis Minimally invasive surgery Transforaminal lumbar interbody fusion Internal fixation |
| 英文摘要: |
| 【Abstract】 Objective：To evaluate the surgical effect of single-level minimally invasive transforaminal lumbar interbody fusion（MiTLIF） for lumbar spine spondylolisthesis.Method：From January 2007 to March 2010，163 cases（61 males and 102 females） suffering lumbar spine spondylolisthesis underwent MiTLIF.The mean age was 51.6 years（range，37-72 years），and the preoperative pathogenesis included degenerative spondylolisthesis（n=97） and isthmic spondylolisthesis（n=66）.There were 135 grade 1 and 28 grade 2 in terms of spondylolisthesis.The involved levels were 7 L3，86 L4 and 70 L5.One-level transforaminal decompression and intebody fusion with bilateral percutaneous pedicle screw fixation under Quadrant retractor system was performed in all cases.All 163 cases were divided into 3 groups chronologically：group A（N0.1 to 55），group B（N0.56 to 110），group C（NO.111 to 163）.The operative time，X-ray exposure time，blood loss and complications were measured and analyzed.Clinical outcome was assessed using the visual analog scale（VAS） and the Oswestry disability index（ODI）.Fusion rates were assessed using CT scan and 3-dimensional reconstruction.Result：163 patients had an average intraoperative blood loss of 330ml（100-750ml），average postoperative blood loss of 57ml（10-175ml），average operative time of 145min（83-230min），average X-ray exposure time of 59s（27-126s）.The intraoperative blood loss and radiation time in group B decreased significantly compared with group A（P<0.05），and these indexes in group C decreased significantly compared with group A and B（P<0.05）.7 cases were complicated with dural tear，4 in group A，2 in group B and 1 in group C，and all were followed by cerebrospinal fluid leakage at the 2nd day after operation and ceased within 5 days after correspondent intervention.Four patients in group A developed onset nerve root irritation after operation and resolved after endoscopic decompression.91 cases were followed up for a mean of 24.5 months（10-47 months）.The VAS score for preoperative，the 3rd day after surgery and final follow up was 6.8±2.4，1.5±0.6 and 0.8±0.4 respectively，which showed significant difference between postoperative and preoperative ones（P<0.05）.The ODI score for preoperative and final follow up was 39.4±5.1 and 11.3±2.6 respectively，which showed significant difference（P<0.05）.The fusion rate at final follow-up was 96.7%（88/91）.Conclusion：MiTLIF is reliable and effective for grades 1 and 2 lumbar spine spondylolisthesis. |
| 投稿时间：2011-01-09 修订日期：2011-03-11 |
| DOI：10.3969/j.issn.1004-406X.2011.5.399.4 |
| 基金项目: |
|
| 摘要点击次数: 3326 |
| 全文下载次数: 2927 |
| 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
