曾顺福,王 建,陆 炎,刘 杰.单节段微创经椎间孔腰椎椎体间融合内固定治疗腰椎滑脱症的效果[J].中国脊柱脊髓杂志,2011,(5):399-403.
单节段微创经椎间孔腰椎椎体间融合内固定治疗腰椎滑脱症的效果
中文关键词:  腰椎滑脱症  微创外科  经椎间孔腰椎间融合术  内固定
中文摘要:
  【摘要】 目的:评价单节段微创经椎间孔腰椎椎体间融合(minimally invasive transforaminal lumbar interbody fusion,MiTLIF)内固定治疗腰椎滑脱症的临床效果。方法:2007年1月~2010年3月163例腰椎滑脱症患者接受单节段MiTLIF和内固定治疗。男61例,女102例;年龄37~72岁,平均51.6岁。退变性腰椎滑脱97例,峡部裂性腰椎滑脱66例;Ⅰ度滑脱135例,Ⅱ度28例;L3滑脱7例,L4 86例,L5 70例。采用经最长肌和多裂肌间隙入路,可扩张工作通道置于关节突上,行MiTLIF和经皮椎弓根螺钉固定。将163例患者按时间顺序依次分为A组(第1~55例)、B组(第56~110例)和C组(第111~163例),统计手术时间、术中X线暴露时间、术中和术后出血量及并发症发生情况,并进行组间比较。采用腰痛视觉模拟评分(VAS)和功能障碍指数(ODI)评分评估临床效果,腰椎薄层CT扫描重建评价椎间融合情况。结果:163例术中出血100~750ml,平均330ml;术后出血10~175ml,平均57ml;手术时间83~230min,平均145min;术中X线暴露时间27~126s,平均59s。B组术中出血量和X线暴露时间与A组比较及C组手术时间、X线暴露时间、术中和术后出血量与A组比较均明显减少(P<0.05);C组手术时间、术中X线暴露时间、术中和术后出血量与B组比较亦明显减少(P<0.05)。7例术中硬膜囊撕裂,其中A组4例,B组2例,C组1例,均在术后第2天出现脑脊液漏,经对症处理术后5d内脑脊液漏停止。4例术后出现新的神经根损害表现,均为A组病例,通过内窥镜下减压和神经根松解后神经根损害症状消失。91例患者获得10~47个月随访,平均24.5个月。术前、术后3d及末次随访腰痛VAS评分分别为6.8±2.4分、1.5±0.6分和0.8±0.4分,术后3d及末次随访与术前比较有显著性差异(P<0.05)。术前及末次随访ODI评分分别为39.4±5.1分和11.3±2.6分,差异有显著性(P<0.05)。末次随访椎间融合率为96.7%(88/91)。结论:采用单节段MiTLIF和经皮椎弓根螺钉固定治疗Ⅰ度、Ⅱ度腰椎滑脱症安全有效。
Clinical outcome of single-level minimally invasive transforaminal lumbar interbody fusion for lumbar spine spondylolisthesis
英文关键词:Lumbar spondylolisthesis  Minimally invasive surgery  Transforaminal lumbar interbody fusion  Internal fixation
英文摘要:
  【Abstract】 Objective:To evaluate the surgical effect of single-level minimally invasive transforaminal lumbar interbody fusion(MiTLIF) for lumbar spine spondylolisthesis.Method:From January 2007 to March 2010,163 cases(61 males and 102 females) suffering lumbar spine spondylolisthesis underwent MiTLIF.The mean age was 51.6 years(range,37-72 years),and the preoperative pathogenesis included degenerative spondylolisthesis(n=97) and isthmic spondylolisthesis(n=66).There were 135 grade 1 and 28 grade 2 in terms of spondylolisthesis.The involved levels were 7 L3,86 L4 and 70 L5.One-level transforaminal decompression and intebody fusion with bilateral percutaneous pedicle screw fixation under Quadrant retractor system was performed in all cases.All 163 cases were divided into 3 groups chronologically:group A(N0.1 to 55),group B(N0.56 to 110),group C(NO.111 to 163).The operative time,X-ray exposure time,blood loss and complications were measured and analyzed.Clinical outcome was assessed using the visual analog scale(VAS) and the Oswestry disability index(ODI).Fusion rates were assessed using CT scan and 3-dimensional reconstruction.Result:163 patients had an average intraoperative blood loss of 330ml(100-750ml),average postoperative blood loss of 57ml(10-175ml),average operative time of 145min(83-230min),average X-ray exposure time of 59s(27-126s).The intraoperative blood loss and radiation time in group B decreased significantly compared with group A(P<0.05),and these indexes in group C decreased significantly compared with group A and B(P<0.05).7 cases were complicated with dural tear,4 in group A,2 in group B and 1 in group C,and all were followed by cerebrospinal fluid leakage at the 2nd day after operation and ceased within 5 days after correspondent intervention.Four patients in group A developed onset nerve root irritation after operation and resolved after endoscopic decompression.91 cases were followed up for a mean of 24.5 months(10-47 months).The VAS score for preoperative,the 3rd day after surgery and final follow up was 6.8±2.4,1.5±0.6 and 0.8±0.4 respectively,which showed significant difference between postoperative and preoperative ones(P<0.05).The ODI score for preoperative and final follow up was 39.4±5.1 and 11.3±2.6 respectively,which showed significant difference(P<0.05).The fusion rate at final follow-up was 96.7%(88/91).Conclusion:MiTLIF is reliable and effective for grades 1 and 2 lumbar spine spondylolisthesis.
投稿时间:2011-01-09  修订日期:2011-03-11
DOI:10.3969/j.issn.1004-406X.2011.5.399.4
基金项目:
作者单位
曾顺福 第三军医大学新桥医院骨科 400037 重庆市 
王 建 第三军医大学新桥医院骨科 400037 重庆市 
陆 炎 第三军医大学新桥医院骨科 400037 重庆市 
刘 杰  
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