微創小切口與開放經椎間孔腰椎椎間融合術治療單節段腰椎退變疾患的近期療效比較_《中國修復重建外科雜志》

作者：

楊進 , 孔清泉 , 宋躍明 , 劉浩 , 曾建成

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

單節段腰椎退變疾患經椎間孔腰椎椎間融合術微創手術開放手術

DOI：

10.7507/1002-1892.20130061

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目的比較微創小切口經椎間孔腰椎椎間融合術（minimally invasive surgery-transforaminal lumbar interbody fusion，MIS-TLIF）與傳統開放TLIF（open-TLIF）治療單節段腰椎退變疾患的近期療效。方法回顧分析2010年2月－2011年2月收治且符合選擇標準的單節段腰椎退變疾患患者臨床資料，其中43例采用MIS-TLIF治療（MIS-TLIF組），104例采用open-TLIF治療（open-TLIF組）。兩組患者性別、年齡、病變類型、病變節段、病程、術前疼痛視覺模擬評分（VAS）及Oswestry功能障礙指數（ODI）比較，差異均無統計學意義（P gt; 0.05），具有可比性。比較兩組手術時間、術中透視時間、術中及術后出血量、術后住院時間及術后并發癥發生情況，行VAS及ODI評分，影像學檢查評價植骨融合情況、內固定物以及Cage位置。結果兩組手術時間相似（t=0.402，P=0.688）；與open-TLIF組相比，MIS-TLIF組術中及術后出血量降低，術后住院時間縮短，但術中透視時間延長，差異均有統計學意義（P lt; 0.05）。術后open-TLIF組出現2例腦脊液漏， 2例切口淺表感染，并發癥發生率為3.8%（4/104）；MIS-TLIF組出現3例背根神經節激惹癥狀，并發癥發生率為7.0%（3/43）；兩組并發癥發生率比較，差異無統計學意義（χ2=0.657，P=0.417）。兩組患者術后均獲隨訪，MIS-TLIF組隨訪時間18～26個月，平均21個月；open-TLIF組18～28個月，平均23個月。術后各時間點兩組患者VAS評分及ODI均較術前顯著改善（P lt; 0.05）。術后出院時及3個月，兩組VAS評分比較差異均無統計學意義（P gt; 0.05）；末次隨訪時，MIS-TLIF組VAS評分顯著低于open-TLIF組（t= —2.022，P=0.047）。術后3個月及末次隨訪時，兩組間ODI比較差異均無統計學意義（P gt; 0.05）。影像學檢查顯示，隨訪期間兩組Cage和內固定物位置良好，植骨均融合。結論MIS-TLIF治療單節段腰椎退變疾患近期療效與open-TLIF相當，同時具有手術創傷小、術后恢復快的優點，但遠期療效需進一步觀察。

引用本文： 楊進,孔清泉,宋躍明,劉浩,曾建成. 微創小切口與開放經椎間孔腰椎椎間融合術治療單節段腰椎退變疾患的近期療效比較. 中國修復重建外科雜志, 2013, 27(3): 262-267. doi: 10.7507/1002-1892.20130061 復制

1.	11 Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 2004, 1(1): 24-30. 12 Holly LT, Schwender JD, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus, 2006, 20(3): E6. 13 Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261. 14 蔣淳, 姜小幸, 馮振洲, 等. 單側置釘經椎間孔椎體融合術結合經椎板的關節突螺釘治療退行性腰椎疾病. 中華臨床醫學, 2010, 17(6): 856-858.
2.	15 Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci, 2012, 19(1): 111-114. 16 O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine, 2009, 11(4): 471-476.
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4.
5.
6.
7.	Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
8.	Styf JR, Willén J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976), 1998, 23(3): 354-358.
9.	Lee SH, Choi WG, Lim SR, et al. Minimally invasive anterior lumbar interody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis. Spine J, 2004, 4(6): 644-649.
10.	Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
11.	Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976), 2001, 26(5): 567-571.
12.	Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg, 2002, 49: 499-517.
13.	Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50(5): 919-926.
14.	Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-years clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
15.	Fessler RG. Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery, 2003, 52(6): 1512.
16.	Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg, 2002, 97(1 Suppl): 7-12.

1. 11 Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 2004, 1(1): 24-30. 12 Holly LT, Schwender JD, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus, 2006, 20(3): E6. 13 Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261. 14 蔣淳, 姜小幸, 馮振洲, 等. 單側置釘經椎間孔椎體融合術結合經椎板的關節突螺釘治療退行性腰椎疾病. 中華臨床醫學, 2010, 17(6): 856-858.
2. 15 Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci, 2012, 19(1): 111-114. 16 O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine, 2009, 11(4): 471-476.
3.
4.
5.
6.
7. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
8. Styf JR, Willén J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976), 1998, 23(3): 354-358.
9. Lee SH, Choi WG, Lim SR, et al. Minimally invasive anterior lumbar interody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis. Spine J, 2004, 4(6): 644-649.
10. Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
11. Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976), 2001, 26(5): 567-571.
12. Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg, 2002, 49: 499-517.
13. Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50(5): 919-926.
14. Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-years clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
15. Fessler RG. Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery, 2003, 52(6): 1512.
16. Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg, 2002, 97(1 Suppl): 7-12.

《中國修復重建外科雜志》

微創小切口與開放經椎間孔腰椎椎間融合術治療單節段腰椎退變疾患的近期療效比較

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《中國修復重建外科雜志》

微創小切口與開放經椎間孔腰椎椎間融合術治療單節段腰椎退變疾患的近期療效比較

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