微创经椎间孔腰椎体间融合术采用混合内固定的学习曲线

The learning curve of minimally invasive transforaminal lumbar interbody fusion hybrid using pedical screws and translamina facet screw system

中文关键词:  经椎间孔腰椎间融合术  经椎板关节突螺钉  微创  学习曲线

英文关键词:Transforaminal lumbar interbody fusion  Translamina facet screw  Minimally invasive  Learning curve

中文摘要:

  【摘要】 目的：探讨微创经椎间孔腰椎体间融合术（minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF）采用椎弓根螺钉结合经椎板关节突螺钉混合内固定的学习曲线。方法：回顾性分析我院2009年10月～2011年7月收治的48例单节段腰椎退变性疾病患者，采用单侧切口进行MIS-TLIF手术，置入单侧椎弓根螺钉后同一切口向对侧置入经椎板关节突螺钉，按时间先后顺序分成A～D四组，每组12例。对手术时间、术中出血量、手术并发症、置入经椎板关节突螺钉失败率、融合率及术后疗效进行组间比较。结果：随访时间12～30个月，平均16.3个月。手术时间A组为139.17±18.32min，B组为115.00±14.62min，C组为110.83±11.04min，D组为110.83±18.32min；术中出血量A组为140.83±33.76ml，B组为83.33±28.39ml，C组为69.17±25.03ml，D组为64.17±25.75ml。B、C、D三组的手术时间和术中出血量均明显小于A组，差异有显著性（P＜0.05），而B、C、D三组组间差异无显著性（P＞0.05）。A组出现并发症3例（25.0%），其中2例硬膜囊破裂和1例神经损伤；B组发生1例硬膜囊破裂（8.3%），C、D组无并发症；A组置入经椎板关节突螺钉失败2例（16.7%），B组失败1例（8.3%），C、D组无失败病例；4组均无不融合病例。四组间并发症发生率、经椎板关节突螺钉置钉失败率及融合率差异无显著性（P＞0.05）。术前腰痛/腿痛VAS评分A组为4.3±3.2分/5.5±3.1分，B组为4.5±3.8分/6.8±3.7分，C组为4.1±3.5分/5.7±3.6分，D组为4.8±3.1分/6.3±4.1分；术后1年时A组为1.3±1.1分/0.4±0.3分，B组为1.4±0.9分/0.3±0.2分，C组为1.2±0.8分/0.3±0.4分，D组为1.4±1.0分/0.2±0.2分。术前ODI评分A组为（40.2±8.1）％，B组为（45.4±9.7）％，C组为（43.2±7.9）％，D组为（39.2±8.4）％；术后1年时A组为（15.2±8.7）%；B组为（14.8±9.4）%；C组为（13.9±8.6）%；D组为（14.1±7.9）%。各组腰痛、腿痛VAS评分及ODI评分术后1年较术前显著改善（P＜0.05），而各组间差异无显著性（P＞0.05）。结论：MIS-TLIF采用混合内固定为直视下操作，大大缩短了学习曲线，可获得可靠的融合和满意的临床效果。

英文摘要:

  【Abstract】 Objectives: To investigate the learning curve of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) hybrid using pedical screws and translamina facet screw. Methods: A retrospective analysis was performed on 48 patients who underwent MIS-TLIF using pedical screws and a translamina facet screw complex in our hospital from October 2009 to July 2011. They were divided chronologically into 4 groups with 12 cases in each group. The operation time, intra-operative blood loss, the operative complications, the instrument failure rate, the fusion rate and the clinical outcomes were recorded and compared between every 2 groups. Results: The mean follow-up was 16.3 months, and the average operation time was (139.17±18.32)min, (115.00±14.62)min, (110.83±11.04)min, and (110.83±18.32)min for group A-D respectively. The average intra-operative blood loss was (140.83±33.76)ml, (83.33±28.39)ml, (69.17±25.03)ml, and (64.17±25.75)ml for group A-D respectively. Group B, C, D had less operation time and blood loss than group A(P＜0.05), while no statistical difference existed among group B, C, D. Complications were noted in 3 patients, which included 2 dura tearing and 1 neurological injury in group A, 1 dura tearing in group B. The instrument failure was noted in 2 patients in group A, 1 in group B. No case of nonunion was found, there was no statistical difference among 4 groups(P＞0.05). The visual analogue scales(VAS) for back and leg pain of each group before operation were as follows: A, (4.3±3.2)/(5.5±3.1), B, (4.5±3.8)/(6.8±3.7); C, (4.1±3.5)/(5.7±3.6), D, (4.8±3.1)/(6.3±4.1); 1 year after operation were as follows: A, (1.3±1.1)/(0.4±0.3); B, (1.4±0.9)/(0.3±0.2); C, (1.2±0.8)/(0.3±0.4); D, (1.4±1.0)/(0.2±0.2). The Oswestry disability index(ODI) scorces of each group before operation were as follows: A, (40.2±8.1)％; B, (45.4±9.7)％; C, (43.2±7.9)％; D, (39.2±8.4)％; 1 year after operation were as follows: A, (15.2±8.7)%; B, (14.8±9.4)%; C, (13.9±8.6)%; D, (14.1±7.9)%, which all showed significant improvement compared with those of preoperation(P＜0.05), but no statistical difference existed among 4 groups(P＞0.05). Conclusions: The MIS-TLIF using pedical screws and a translamina facet screw complex working under straight view, that can significantly lower the the learning curve, improve fusion rate and clinical outcome.