顯微鏡輔助下微創經椎間孔腰椎椎間融合術治療腰椎退行性疾病的療效觀察_《中國修復重建外科雜志》

作者：

張文志 , 段麗群 , 尚希福 , 許翔 , 胡業豐 , 賀瑞

安徽醫科大學附屬安徽省立醫院骨二科（合肥，230001）;

關鍵詞：

腰椎退行性疾病經椎間孔腰椎椎間融合術微創手術

DOI：

10.7507/1002-1892.20130062

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的探討顯微鏡輔助下微創經椎間孔腰椎椎間融合術（transforaminal lumbar interbody fusion，TLIF）治療腰椎退行性疾病的療效。方法回顧分析2010年1月－2011年6月采用顯微鏡輔助下微創TLIF治療的82例腰椎退行性疾病患者（微創組）臨床資料，與同期行傳統開放TLIF治療的76例患者（傳統組）進行比較。兩組患者性別、年齡、病程、病變類型、病變節段、術前Oswestry功能障礙指數（ODI）及疼痛視覺模擬評分（VAS）比較，差異均無統計學意義（P gt; 0.05），具有可比性。比較兩組患者圍手術期相關參數及影像學、臨床療效評定結果。結果兩組手術時間和術中放射線暴露時間比較，差異均無統計學意義（P gt; 0.05）；但微創組術中出血量、術后引流量均顯著低于傳統組（P lt; 0.05）。術中傳統組2例出現硬膜撕裂；術后兩組各1例發生切口淺表感染，其余患者切口均Ⅰ期愈合。兩組患者均獲隨訪，隨訪時間12～28個月，平均18個月。X線片示均無內固定物斷裂及松動等并發癥發生。末次隨訪時，微創組和傳統組植骨融合率分別為95.1%（78/82）和96.1%（73/76），比較差異無統計學意義（χ2=0.012 2，P=0.912 0）。兩組術后各時間點ODI均較術前顯著改善（P lt; 0.05）；微創組術后3個月時ODI顯著優于傳統組（t= —11.941 1，P=0.000 0），但術后1年及末次隨訪時兩組差異無統計學意義（P gt; 0.05）。兩組術后各時間點VAS評分與術前比較，差異均有統計學意義（P lt; 0.05）；微創組術后1 d及3個月時VAS評分顯著低于傳統組（P lt; 0.05），但術后1年及末次隨訪時兩組差異無統計學意義（P gt; 0.05）。結論顯微鏡輔助下微創TLIF治療腰椎退行性疾病安全可靠、創傷小、出血少、術后疼痛輕，近期療效與傳統開放TLIF相當。

引用本文： 張文志,段麗群,尚希福,許翔,胡業豐,賀瑞. 顯微鏡輔助下微創經椎間孔腰椎椎間融合術治療腰椎退行性疾病的療效觀察. 中國修復重建外科雜志, 2013, 27(3): 268-272. doi: 10.7507/1002-1892.20130062 復制

1.	Harms J, Jeszenszky D, Stolze D, et al. True spondylolisthosis reduction and more segraental fusion in spondylolisthesis//Harms J. Textbook of Spinal Surgery. Philadelphia: Lippincott-Raven, 1997: 1337-1347.
2.	Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2): 210-220.
3.	Shah RR, Mohammed S, Saifuddin A, et al. Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedieular instrumentation. Eur Spine J, 2003, 12(4): 378-385．.
4.	Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
5.	Wild MH, Gless M, Plieschnegger C, et al. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percuta- neously and conventionally open treated patients. Arch Orthop Trauma Surg, 2007, 127(5): 335-343.
6.	Stevens KJ, Spenciner DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech, 2006, 19(2): 77-86．.
7.	Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
8.	Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1: S1-6.
9.	Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy assisted transforaminal interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
10.	Rouben D, Casnellie M, Ferguson M. Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up. J Spinal Disord Tech, 2011, 24(5): 288-296.
11.	顧廣飛, 張海龍, 賀石, 等. 微創經椎間孔腰椎體間融合術治療腰椎管狹窄合并腰椎不穩癥. 中華外科雜志, 2011, 49(12): 1081-1085.
12.	Lau D, Ziewacz J, Park P. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity. J Clin Neurosci, 2013, 20(1): 80-83.
13.	Tsahtsarlis A, Wood M. Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease. Eur Spine J, 2012, 21(11): 2300-2305.
14.	Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2012 , 21(11): 2265-2270.
15.	Meyer SA, Wu JC, Mummaneni PV. Mini-open and minimally invasive transforaminal lumbar interbody fusion: technique review. Semin Spine Surg, 2011, 23(1): 45-50.
16.	Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S294-301.
17.	王建, 周躍, 張正豐, 等. 微創經椎間孔腰椎體間融合術治療腰椎滑脫癥的臨床研究. 中華外科雜志, 2011, 49(12): 1076-1080.
18.	Theocharopoulos N, Damilakis J, Perisinakis K, et al. Occupational gonadal and embryo/fetal doses from fluoroscopically assisted surgical treatments of spinal disorders. Spine (Phila Pa 1976), 2004, 29(22): 2573-2580.
19.	Theocharopoulos N, Perisinakis K, Damilakis J, et al. Occupational exposure from common fluoroscopic projections used in orthopaedic surgery. J Bone Joint Surg (Am), 2003, 85-A(9): 1698-1703.
20.	Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261.
21.	Zhou Y, Zhang C, Wang J, et al. Endoscopic transforaminal lumbar decompression, interbody fusion and pedicle screw fixation-a report of 42 cases. Chin J Traumatol, 2008, 11(4): 225-231.
22.	張紹東, 王宸, 陳輝, 等. 微創經椎間孔椎間融合術治療腰椎退行性疾病. 中華外科雜志, 2009, 47(2): 112-115.
23.	Lau D, Lee JG, Han SJ, et al. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci, 2011, 18(5): 624-627.
24.	Lee JC, Jang HD, Shin BJ. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine (Phila Pa 1976), 2012, 37(18): 1548-1557.

1. Harms J, Jeszenszky D, Stolze D, et al. True spondylolisthosis reduction and more segraental fusion in spondylolisthesis//Harms J. Textbook of Spinal Surgery. Philadelphia: Lippincott-Raven, 1997: 1337-1347.
2. Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2): 210-220.
3. Shah RR, Mohammed S, Saifuddin A, et al. Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedieular instrumentation. Eur Spine J, 2003, 12(4): 378-385．.
4. Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
5. Wild MH, Gless M, Plieschnegger C, et al. Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures: a comparison of minimally invasive percuta- neously and conventionally open treated patients. Arch Orthop Trauma Surg, 2007, 127(5): 335-343.
6. Stevens KJ, Spenciner DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech, 2006, 19(2): 77-86．.
7. Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
8. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1: S1-6.
9. Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy assisted transforaminal interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
10. Rouben D, Casnellie M, Ferguson M. Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up. J Spinal Disord Tech, 2011, 24(5): 288-296.
11. 顧廣飛, 張海龍, 賀石, 等. 微創經椎間孔腰椎體間融合術治療腰椎管狹窄合并腰椎不穩癥. 中華外科雜志, 2011, 49(12): 1081-1085.
12. Lau D, Ziewacz J, Park P. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity. J Clin Neurosci, 2013, 20(1): 80-83.
13. Tsahtsarlis A, Wood M. Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease. Eur Spine J, 2012, 21(11): 2300-2305.
14. Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2012 , 21(11): 2265-2270.
15. Meyer SA, Wu JC, Mummaneni PV. Mini-open and minimally invasive transforaminal lumbar interbody fusion: technique review. Semin Spine Surg, 2011, 23(1): 45-50.
16. Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S294-301.
17. 王建, 周躍, 張正豐, 等. 微創經椎間孔腰椎體間融合術治療腰椎滑脫癥的臨床研究. 中華外科雜志, 2011, 49(12): 1076-1080.
18. Theocharopoulos N, Damilakis J, Perisinakis K, et al. Occupational gonadal and embryo/fetal doses from fluoroscopically assisted surgical treatments of spinal disorders. Spine (Phila Pa 1976), 2004, 29(22): 2573-2580.
19. Theocharopoulos N, Perisinakis K, Damilakis J, et al. Occupational exposure from common fluoroscopic projections used in orthopaedic surgery. J Bone Joint Surg (Am), 2003, 85-A(9): 1698-1703.
20. Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261.
21. Zhou Y, Zhang C, Wang J, et al. Endoscopic transforaminal lumbar decompression, interbody fusion and pedicle screw fixation-a report of 42 cases. Chin J Traumatol, 2008, 11(4): 225-231.
22. 張紹東, 王宸, 陳輝, 等. 微創經椎間孔椎間融合術治療腰椎退行性疾病. 中華外科雜志, 2009, 47(2): 112-115.
23. Lau D, Lee JG, Han SJ, et al. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci, 2011, 18(5): 624-627.
24. Lee JC, Jang HD, Shin BJ. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine (Phila Pa 1976), 2012, 37(18): 1548-1557.

《中國修復重建外科雜志》

顯微鏡輔助下微創經椎間孔腰椎椎間融合術治療腰椎退行性疾病的療效觀察

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國修復重建外科雜志》

顯微鏡輔助下微創經椎間孔腰椎椎間融合術治療腰椎退行性疾病的療效觀察

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料