小切口經椎間孔神經管減壓椎間融合治療退變性腰椎側彎性椎管狹窄_《中國修復重建外科雜志》

作者：

丁悅 ¹ , 賀石生 ² , 張海龍 ²

1復旦大學附屬金山醫院骨科（上海，201508）;;
2同濟大學附屬第十人民醫院骨科;

關鍵詞：

退變性腰椎側彎椎管狹窄腰椎融合微創手術

DOI：

10.7507/1002-1892.20130095

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目的總結擴張通道下小切口經椎間孔神經管減壓椎間融合（minimally invasive transforaminal lumbar interbody fusion，MI-TLIF）輔以椎弓根螺釘內固定治療退變性腰椎側彎性椎管狹窄的臨床療效。方法2009年4月－2010年10月，采用擴張通道下MI-TLIF輔以椎弓根螺釘內固定治療退變性腰椎側彎性椎管狹窄患者20例（A組），與同期行傳統后路開放減壓椎間融合椎弓根螺釘內固定方法治療的19例（B組）進行療效比較。兩組患者性別、年齡、病程、腰椎退變性側彎范圍及術前腰痛和腿痛視覺模擬評分（VAS）、Oswestry功能障礙指數（ODI）評分、Cobb角等一般資料比較差異均無統計學意義（P gt; 0.05），具有可比性。比較兩組患者手術時間、術中出血量、術后自主翻身時間、術后并發癥發生率、植骨融合率、Cobb角、ODI評分及腰、腿痛VAS評分等指標。結果A組手術時間顯著長于B組，術中出血量顯著少于B組，差異均有統計學意義（P lt; 0.05）；術后自主翻身時間兩組比較差異無統計學意義（t=1.869，P=0.069）。A、B組并發癥發生率分別為20.0%（4/20）和26.3%（5/19），比較差異無統計學意義（χ2=0.219，P=0.640）。39例均獲隨訪，隨訪時間2年～3年6個月，平均2.9年。末次隨訪時A、B組植骨融合率分別為92.9%（78/84）和95.2%（80/84），比較差異無統計學意義（χ2=0.425，P=0.514）。根據Macnab標準評定療效，A組獲優12例，良6例，可1例，差1例，優良率90.0%；B組獲優12例，良5例，可2例，優良率89.5%；兩組比較差異無統計學意義（Z= —0.258，P=0.835）。兩組術后腰、腿痛VAS評分、ODI評分及Cobb角均較術前顯著改善，差異有統計學意義（P lt; 0.05）；術后2周及末次隨訪時兩組間各指標比較差異均無統計學意義（P gt; 0.05）。結論擴張通道下MI-TLIF輔以椎弓根螺釘內固定術可用于治療退變性腰椎側彎性椎管狹窄，臨床療效與傳統后路開放減壓椎間融合椎弓根螺釘內固定術相似，且術中出血少，對組織損傷小。

引用本文： 丁悅,賀石生,張海龍. 小切口經椎間孔神經管減壓椎間融合治療退變性腰椎側彎性椎管狹窄. 中國修復重建外科雜志, 2013, 27(4): 404-408. doi: 10.7507/1002-1892.20130095 復制

1.	Akbarnia BA, Ogilvie JW, Hammerberg KW. Debate: degenerative scoliosis: to operate or not operate. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S195-201.
2.	Crawford CH 3rd, Glassman SD. Surgical treatment of lumbar spinal stenosis associated with adult scoliosis. Instr Course Lect, 2009, 58: 669-676.
3.	Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J, 2007, 7(4): 428-436.
4.	Hey HW, Hee HT. Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF. Indian J Orthop, 2010, 44(2): 159-162.
5.	賀石生, 張海龍, 顧昕, 等. 腰椎微創手術術前定位器的設計及臨床應用. 中華骨科雜志, 2011, 31(10): 1170-1171.
6.	Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
7.	Benglis DM, Elhammady MS, Levi AD, et al. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery, 2008, 63(3 Suppl): 191-196.
8.	Tsai TH, Huang TY, Lieu AS, et al. Functional outcome analysis: instrumented posterior lumbar interbody fusion for degenerative lumbar scoliosis. Acta Neurochir (Wien), 2011, 153(3): 547-555.
9.	Nasca RJ. Lumbar spinal stenosis: surgical considerations. J South Orthop Assoc, 2002, 11(3): 127-134.
10.	許國華, 葉曉健, 袁文, 等. 腰椎退變性側彎伴椎管狹窄的外科治療. 頸腰痛雜志, 2009, 30(4): 294-297.
11.	Frazier DD, Lipson SJ, Fossel AH, et al. Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine (Phila Pa 1976), 1997, 22(17): 2025-2029.
12.	Transfeldt EE, Topp R, Mehbod AA, et al. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine (Phila Pa 1976), 2010, 35(20): 1872-1875.
13.	Truumees E. Spinal stenosis: Pathophysiology, clinical and radiologic classification. Instr Course Lect, 2005, 54: 287-302.
14.	Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res, 2001, (384): 45-53.
15.	Liu H, Ishihara H, Kanamori M, et al. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine (Phila Pa 1976), 2003, 3(6): 524-529.
16.	Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J, 2005, 14(9): 887-894.
17.	Scheufler KM, Cyron D, Dohmen H, et al. Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome. Neurosurgery, 2010, 67(6): 1609-1621.
18.	Li F, Chen Q, Chen W, et al. Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis. J Spinal Disord Tech, 2011, 24(5): 308-312.
19.	賀石生. 微創可擴張通道輔助腰椎融合術之管見. 中華骨科雜志, 2011, 31(10): 1022-1023.

1. Akbarnia BA, Ogilvie JW, Hammerberg KW. Debate: degenerative scoliosis: to operate or not operate. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S195-201.
2. Crawford CH 3rd, Glassman SD. Surgical treatment of lumbar spinal stenosis associated with adult scoliosis. Instr Course Lect, 2009, 58: 669-676.
3. Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J, 2007, 7(4): 428-436.
4. Hey HW, Hee HT. Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF. Indian J Orthop, 2010, 44(2): 159-162.
5. 賀石生, 張海龍, 顧昕, 等. 腰椎微創手術術前定位器的設計及臨床應用. 中華骨科雜志, 2011, 31(10): 1170-1171.
6. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
7. Benglis DM, Elhammady MS, Levi AD, et al. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery, 2008, 63(3 Suppl): 191-196.
8. Tsai TH, Huang TY, Lieu AS, et al. Functional outcome analysis: instrumented posterior lumbar interbody fusion for degenerative lumbar scoliosis. Acta Neurochir (Wien), 2011, 153(3): 547-555.
9. Nasca RJ. Lumbar spinal stenosis: surgical considerations. J South Orthop Assoc, 2002, 11(3): 127-134.
10. 許國華, 葉曉健, 袁文, 等. 腰椎退變性側彎伴椎管狹窄的外科治療. 頸腰痛雜志, 2009, 30(4): 294-297.
11. Frazier DD, Lipson SJ, Fossel AH, et al. Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine (Phila Pa 1976), 1997, 22(17): 2025-2029.
12. Transfeldt EE, Topp R, Mehbod AA, et al. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine (Phila Pa 1976), 2010, 35(20): 1872-1875.
13. Truumees E. Spinal stenosis: Pathophysiology, clinical and radiologic classification. Instr Course Lect, 2005, 54: 287-302.
14. Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res, 2001, (384): 45-53.
15. Liu H, Ishihara H, Kanamori M, et al. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine (Phila Pa 1976), 2003, 3(6): 524-529.
16. Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J, 2005, 14(9): 887-894.
17. Scheufler KM, Cyron D, Dohmen H, et al. Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome. Neurosurgery, 2010, 67(6): 1609-1621.
18. Li F, Chen Q, Chen W, et al. Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis. J Spinal Disord Tech, 2011, 24(5): 308-312.
19. 賀石生. 微創可擴張通道輔助腰椎融合術之管見. 中華骨科雜志, 2011, 31(10): 1022-1023.

《中國修復重建外科雜志》

小切口經椎間孔神經管減壓椎間融合治療退變性腰椎側彎性椎管狹窄

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《中國修復重建外科雜志》

小切口經椎間孔神經管減壓椎間融合治療退變性腰椎側彎性椎管狹窄

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