微創與開放經椎間孔腰椎椎間融合術對比研究進展_《中國修復重建外科雜志》

作者：

蘇鍇 , 郭營 , 張忠民 , 金大地

南方醫科大學第三附屬醫院骨科中心廣東省骨科研究院（廣州，510630）;

關鍵詞：

經椎間孔腰椎椎間融合術微創手術開放手術對比研究

DOI：

10.7507/1002-1892.20130300

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的對微創與開放經椎間孔腰椎椎間融合術（transforaminal lumbar interbody fusion，TLIF）的對比研究進展進行綜述。方法廣泛查閱國內外近年來關于微創和開放TLIF對比研究的相關文獻，分別從術中指標、住院時間、臨床療效、并發癥、融合率和對椎旁肌影響5個方面進行分析總結。結果微創TLIF具有術中出血少、住院時間短等優點，但手術時間及透視時間較長。微創手術與開放手術均能獲得較高的融合率，但微創手術的臨床療效并未優于開放手術，且并發癥發生率相對較高。在肌酸激酶、多裂肌橫截面積和萎縮分級上，微創手術未明顯減少對椎旁肌的損傷。結論微創TLIF并未明顯優于開放TLIF，也未明顯減少對椎旁肌的損傷；二者療效差異尚需前瞻性雙盲隨機對照試驗進一步研究。

引用本文： 蘇鍇,郭營,張忠民,金大地. 微創與開放經椎間孔腰椎椎間融合術對比研究進展. 中國修復重建外科雜志, 2013, 27(11): 1386-1389. doi: 10.7507/1002-1892.20130300 復制

1.	Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg, 1953, 10(2): 154-168.
2.	Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg, 1956, 44(185): 266-275.
3.	Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am, 2002, 33(2): 359-366.
4.	Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
5.	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.
6.	Schizas C, Tzinieris N, Tsiridis E, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop, 2009, 33(6): 1683-1688.
7.	Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385-1389.
8.	Villavicencio AT, Burneikiene S, Roeca CM, et al. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int, 2010, 1: 12.
9.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
10.	Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine, 2008, 9(6): 560-565.
11.	Epstein NE. How often is minimally invasive minimally effective: what are the complication rates for minimally invasive surgery? Surg Neurol, 2008, 70(4): 386-389.
12.	Ebata S, Sato H, Orii H, et al. Risk management in posterior spinal endoscopic surgery in lumbar diseases. J Orthop Sci, 2013, 18(3): 369-373.
13.	Wu RH, Fraser JF, Hartl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine (Phila Pa 1976), 2010, 35(26): 2273-2281.
14.	Kuriyama N, Ito H. Electromyographic functional analysis of the lumbar spinal muscles with low back pain. J Nippon Med Sch, 2005, 72(3): 165-173.
15.	Min SH, Kim MH, Seo JB, et al. The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J, 2009, 3(2): 89-95.
16.	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.
17.	Wang HL, Lu FZ, Jiang JY, et al. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J (Engl), 2011, 124(23): 3868-3874.
18.	Adogwa O, Johnson K, Min ET, et al. Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study. Surg Neurol Int, 2012, 3(Suppl 5): S355-361.
19.	Hu Y, Leung HB, Lu WW, et al. Histologic and electrophysiological changes of the paraspinal muscle after spinal fusion: an experimental study. Spine (Phila Pa 1976), 2008, 33(13): 1418-1422.
20.	Payer M. “Minimally invasive” lumbar spine surgery: a critical review. Acta Neurochir (Wien), 2011, 153(7): 1455-1459.
21.	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: S1-6.
22.	Dasenbrock HH, Juraschek SP, Schultz LR, et al. The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. J Neurosurg Spine, 2012, 16(5): 452-462.
23.	Epstein NE. Minimally invasive/endoscopic vs “open” posterior cervical laminoforaminotomy: do the risks outweigh the benefits? Surg Neurol, 2009, 71(3): 330-331.
24.	Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine (Phila Pa 1976), 1994, 19(22): 2598-2602.
25.	Gejo R, Matsui H, Kawaguchi Y, et al. Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976), 1999, 24(10): 1023-1028.
26.	Styf JR, Willen 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.
27.	Datta G, Gnanalingham KK, Peterson D, et al. Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction? Neurosurgery, 2004, 54(6): 1413-1420.
28.	Taylor H, Mcgregor AH, Medhi-Zadeh S, et al. The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine (Phila Pa 1976), 2002, 27(24): 2758-2762.

1. Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg, 1953, 10(2): 154-168.
2. Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg, 1956, 44(185): 266-275.
3. Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am, 2002, 33(2): 359-366.
4. Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
5. 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.
6. Schizas C, Tzinieris N, Tsiridis E, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop, 2009, 33(6): 1683-1688.
7. Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385-1389.
8. Villavicencio AT, Burneikiene S, Roeca CM, et al. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int, 2010, 1: 12.
9. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
10. Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine, 2008, 9(6): 560-565.
11. Epstein NE. How often is minimally invasive minimally effective: what are the complication rates for minimally invasive surgery? Surg Neurol, 2008, 70(4): 386-389.
12. Ebata S, Sato H, Orii H, et al. Risk management in posterior spinal endoscopic surgery in lumbar diseases. J Orthop Sci, 2013, 18(3): 369-373.
13. Wu RH, Fraser JF, Hartl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine (Phila Pa 1976), 2010, 35(26): 2273-2281.
14. Kuriyama N, Ito H. Electromyographic functional analysis of the lumbar spinal muscles with low back pain. J Nippon Med Sch, 2005, 72(3): 165-173.
15. Min SH, Kim MH, Seo JB, et al. The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J, 2009, 3(2): 89-95.
16. 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.
17. Wang HL, Lu FZ, Jiang JY, et al. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J (Engl), 2011, 124(23): 3868-3874.
18. Adogwa O, Johnson K, Min ET, et al. Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study. Surg Neurol Int, 2012, 3(Suppl 5): S355-361.
19. Hu Y, Leung HB, Lu WW, et al. Histologic and electrophysiological changes of the paraspinal muscle after spinal fusion: an experimental study. Spine (Phila Pa 1976), 2008, 33(13): 1418-1422.
20. Payer M. “Minimally invasive” lumbar spine surgery: a critical review. Acta Neurochir (Wien), 2011, 153(7): 1455-1459.
21. 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: S1-6.
22. Dasenbrock HH, Juraschek SP, Schultz LR, et al. The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. J Neurosurg Spine, 2012, 16(5): 452-462.
23. Epstein NE. Minimally invasive/endoscopic vs “open” posterior cervical laminoforaminotomy: do the risks outweigh the benefits? Surg Neurol, 2009, 71(3): 330-331.
24. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine (Phila Pa 1976), 1994, 19(22): 2598-2602.
25. Gejo R, Matsui H, Kawaguchi Y, et al. Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976), 1999, 24(10): 1023-1028.
26. Styf JR, Willen 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.
27. Datta G, Gnanalingham KK, Peterson D, et al. Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction? Neurosurgery, 2004, 54(6): 1413-1420.
28. Taylor H, Mcgregor AH, Medhi-Zadeh S, et al. The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine (Phila Pa 1976), 2002, 27(24): 2758-2762.

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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對比研究進展

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