微創與開放經椎間孔腰椎椎間融合術組織創傷相關血清指標的比較研究_《中國修復重建外科雜志》

作者：

鄒澍 , 王建 , 潘文琦 , 鄭勇 , 黃博

第三軍醫大學新橋醫院骨科（重慶，400037）;

關鍵詞：

組織創傷炎性反應經椎間孔腰椎椎間融合術微創手術開放手術腰椎退行性疾病

DOI：

10.7507/1002-1892.20130209

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目的比較微創經椎間孔腰椎椎間融合術（transforaminal lumbar interbody fusion，TLIF）與開放TLIF治療腰椎退行性疾病組織創傷相關血清指標差異，分析其意義。方法將2012年5月－11月符合選擇標準的60例患者納入研究，根據患者對手術方式認同度、經濟條件等情況確定手術方式，行Quadrant可擴張工作通道下經椎間孔椎管減壓、椎間植骨融合、Sextant椎弓根螺釘內固定手術（微創組）及傳統開放TLIF手術（開放組）各30例。兩組患者性別、年齡、病變類型、病變節段、病程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。分別記錄患者手術時間、術中出血量、術后住院時間等；應用疼痛視覺模擬評分（VAS）評估患者術后切口疼痛程度。檢測兩組患者術前及術后24 h C反應蛋白（C-reactive protein，CRP）濃度及肌酸激酶（creatine kinase，CK）活性；以及術前和術后2、4、8、24 h患者血清中IL-6、IL-10及TNF-α的濃度。結果微創組手術時間、術中出血量、術后住院時間及術后1～3 d切口VAS評分均少于開放組，差異有統計學意義（P lt; 0.05）。兩組術前血清CRP濃度、CK活性、IL-6、IL-10及TNF-α濃度比較，差異均無統計學意義（P gt; 0.05）；術后24 h，微創組CRP濃度、CK活性及術后各時間點IL-6、IL-10濃度均低于開放組，差異均有統計學意義（P lt; 0.05），兩組TNF-α濃度差異無統計學意義（P gt; 0.05）。結論微創TLIF導致的組織創傷及系統炎性反應較開放TLIF輕，對患者造成的手術創傷較小。

引用本文： 鄒澍,王建,潘文琦,鄭勇,黃博. 微創與開放經椎間孔腰椎椎間融合術組織創傷相關血清指標的比較研究. 中國修復重建外科雜志, 2013, 27(8): 960-964. doi: 10.7507/1002-1892.20130209 復制

1.	Cutler AR, Siddiqui S, Mohan AL, et al. Comparison of polyetheretherketone cage with emoral cortical bone allograft as a single-piece interbody spacer in tranaforaminal lumbar interbody fusion. J Neurosurg Spine, 2007, 5(6): 534-539.
2.	Lowe TG, Tahernia AD, O’Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2 year results. J Spinal Disord Tech, 2002, 15(1): 31-38.
3.	李兵, 胡朝暉, 卓祥龍. 經椎間孔椎體間融合治療退行性腰椎間盤病. 中國修復重建外科雜志, 2008, 22(8): 914-917.
4.	Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
5.	Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive trmasforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1: S1-6.
6.	Seheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 Suppl 2): 203-213.
7.	Thelander U, Larsson S. Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery. Spine (Phila Pa 1976), 1997, 17(4): 400-404.
8.	Takahashi J, Ebara S, Kamimura M, et al. Early-phase enhanced inflammatory reaction after spinal in-strumentation surgery. Spine (Phila Pa 1976), 2001, 26(15): 1698-1704.
9.	Kawaguchi Y, Matsui H, Tsuji H, et al. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
10.	Kawaguchi Y, Yabuki S, Styf J, et al. Back muscle injury after posterior lumbar spine surgery. Topographic evlanation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine (Phila Pa 1976), 1996, 21(22): 2683-2688.
11.	王建, 張正豐, 李長青, 等. 微創經椎間孔腰椎椎間融合術翻修治療腰椎退變性疾病. 脊柱外科雜志, 2012, 10(1): 13-16.
12.	Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TILF). Eur Spine J, 2005, 14(9): 887-894.
13.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
14.	Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10): 1780-1784.
15.	梁博偉, 殷國前, 趙勁民, 等. 微創經椎間孔椎間融合術治療退變性腰椎失穩. 中國修復重建外科雜志, 2011, 25(12): 1449-1454.
16.	Huang TJ, Hsu RW, Li YY, et al. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res, 2005, 23(2): 406-411.
17.	Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976), 1997, 22(9): 1018-1023.
18.	張超, 周躍, 初同偉, 等. 椎間盤鏡下與開放手術治療腰椎間盤突出癥對椎旁肌損傷程度的比較研究. 中國骨與關節損傷雜志, 2006, 21(4): 287-289.
19.	Kim YI, Song KE, Ryeon HK, et al. Enhanced inflammatory cytokine Production at ischemia/reperfusion in human liver resection. Hepatogastroenterology, 2002, 49(46): 1077-1082.
20.	Gogos CA, Drosou E, Bassaris HP, et al. Pro- versus anti-inflammatory cytokine profile in patients with severe sepsis: a marker for prognosis and future therapeutic options. J Infect Dis, 2000, 181(1): 176-180.

1. Cutler AR, Siddiqui S, Mohan AL, et al. Comparison of polyetheretherketone cage with emoral cortical bone allograft as a single-piece interbody spacer in tranaforaminal lumbar interbody fusion. J Neurosurg Spine, 2007, 5(6): 534-539.
2. Lowe TG, Tahernia AD, O’Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2 year results. J Spinal Disord Tech, 2002, 15(1): 31-38.
3. 李兵, 胡朝暉, 卓祥龍. 經椎間孔椎體間融合治療退行性腰椎間盤病. 中國修復重建外科雜志, 2008, 22(8): 914-917.
4. Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
5. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive trmasforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1: S1-6.
6. Seheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 Suppl 2): 203-213.
7. Thelander U, Larsson S. Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery. Spine (Phila Pa 1976), 1997, 17(4): 400-404.
8. Takahashi J, Ebara S, Kamimura M, et al. Early-phase enhanced inflammatory reaction after spinal in-strumentation surgery. Spine (Phila Pa 1976), 2001, 26(15): 1698-1704.
9. Kawaguchi Y, Matsui H, Tsuji H, et al. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
10. Kawaguchi Y, Yabuki S, Styf J, et al. Back muscle injury after posterior lumbar spine surgery. Topographic evlanation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine (Phila Pa 1976), 1996, 21(22): 2683-2688.
11. 王建, 張正豐, 李長青, 等. 微創經椎間孔腰椎椎間融合術翻修治療腰椎退變性疾病. 脊柱外科雜志, 2012, 10(1): 13-16.
12. Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TILF). Eur Spine J, 2005, 14(9): 887-894.
13. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
14. Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10): 1780-1784.
15. 梁博偉, 殷國前, 趙勁民, 等. 微創經椎間孔椎間融合術治療退變性腰椎失穩. 中國修復重建外科雜志, 2011, 25(12): 1449-1454.
16. Huang TJ, Hsu RW, Li YY, et al. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res, 2005, 23(2): 406-411.
17. Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976), 1997, 22(9): 1018-1023.
18. 張超, 周躍, 初同偉, 等. 椎間盤鏡下與開放手術治療腰椎間盤突出癥對椎旁肌損傷程度的比較研究. 中國骨與關節損傷雜志, 2006, 21(4): 287-289.
19. Kim YI, Song KE, Ryeon HK, et al. Enhanced inflammatory cytokine Production at ischemia/reperfusion in human liver resection. Hepatogastroenterology, 2002, 49(46): 1077-1082.
20. Gogos CA, Drosou E, Bassaris HP, et al. Pro- versus anti-inflammatory cytokine profile in patients with severe sepsis: a marker for prognosis and future therapeutic options. J Infect Dis, 2000, 181(1): 176-180.

《中國修復重建外科雜志》

微創與開放經椎間孔腰椎椎間融合術組織創傷相關血清指標的比較研究

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《中國修復重建外科雜志》

微創與開放經椎間孔腰椎椎間融合術組織創傷相關血清指標的比較研究

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