微创经椎间孔腰椎体间融合术的围手术期并发症

Perioperative complications of minimally invasive transforaminal lumbar interbody fusion

中文关键词:  腰椎退变性疾病  微创外科  经椎间孔腰椎体间融合  并发症

英文关键词:Lumbar degenerative diseases  Minimally invasive surgery  Transforaminal lumbar interbody fusion  Complications

中文摘要:

  【摘要】 目的：分析微创经椎间孔腰椎体间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）的围手术期并发症发生情况。方法：对2007年6月～2013年7月接受MIS-TLIF治疗的523例腰椎退变性疾病患者的临床资料进行回顾性分析。男231例，女292例，年龄53.1±8.4岁（31～83岁）。其中腰椎滑脱症194例，腰椎管狭窄症128例，腰椎不稳症62例，巨大腰椎间盘脱出症59例，腰椎术后复发52例（开放腰椎间盘切除术后复发26例，显微内窥镜下椎间盘切除术后复发17例，经皮内窥镜下椎间盘切除术后复发9例），退变性椎间盘病（degenerative disc disease，DDD）28例。围手术期并发症定义为手术后1个月内发生的与手术直接相关的并发症。持久并发症指手术导致新的损害术后持续大于30d无改善，短暂并发症指手术导致新的损害在术后30d内获得改善。统计分析并发症发生情况及原因。结果：本组523例平均随访47.5±8.2个月（24～81个月）。92例患者共计发生围手术期并发症96例次，其中持久并发症2例次，分别为1例因为椎弓根解剖结构畸形在螺钉置入时造成神经根损伤和1例操作失误导致出行神经根损伤，神经功能部分恢复。90例发生短暂性并发症94例次，其中最常见为下肢麻木不适，发生率为10.71%（56/523），发生硬膜撕裂21例，表浅感染9例，局部血肿4例，神经卡压2例，深部感染1例，植骨移位1例。88例患者发生单项并发症，4例发生2项并发症，围手术期并发症发生率为17.59%（92/523）。不同疾病并发症率分别为：腰椎滑脱症17.53%，腰椎管狭窄症17.19%，腰椎不稳14.52%，巨大腰椎间盘脱出13.56%，腰椎术后翻修30.77%，退变性椎间盘病10.71%。单节段融合并发症率（17.53%）和双节段融合并发症发生率（18.42%）统计学差异不显著（χ2=0.02，P＞0.05）。结论：MIS-TLIF围手术期并发症包括神经根损伤、硬膜撕裂、切口感染和短暂性下肢麻木等，短暂性下肢麻木是最常见并发症。

英文摘要:

  【Abstract】 Objectives: To analyze the perioperative complications relative to minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) for degenerative lumbar diseases, and to explore the prophylactic and therapeutic measures. Methods: The clinical data of 523 MIS-TLIF surgeries on degenerative lumbar diseases, performed between June 2007 and July 2013, were collected in a retrospective study. The study group comprised 523 patients with a mean age of 53.1±8.4 years(range, 31-83 years), which included 231 males and 292 females. The degenerative lumbar diseases included lumbar spondylolisthesis in 194 cases, lumbar stenosis in 128 cases, lumbar instability in 62 cases, massive lumbar disc herniation in 59 cases, recurrent lumbar diseases in 52 cases including 26 cases after open lumbar discectomy, 17 cases after microendoscopic discectomy and 9 cases after percutaneous endoscopic lumbar discectomy, and degenerative disc disease(DDD) in 28 cases. Perioperative complications were defined as those occurred within 1 month postoperatively. Persistent complications were defined as a new deficit extending more than 30 days without improvement after the surgery. Transient complications were defined as a new deficit resulting from the procedure, which improved within 30 days of the surgical intervention. The incidence and cause of complications were analyzed, and the prophylactic and therapeutic measures were discussed. Results: The average follow-up period was 47.5±8.2 months(range, 24-81 months). Amomg 96 perioperative complications observed in 523 patients, 2 persistent complications including one direct injury to nerve root caused by hardware malposition as a result of pedicle anatomic deformity and one direct injury to exiting nerve root caused by manipulative error which led to persistent nerve dysfunction, and 94 transient complications occurred. Among 94 transient complications, leg numbness was the most common complication with an incidence rate of 10.71%(56/523). Dural tears occurred in 21 cases, superficial wound infection in 9 cases, and deep wound infection in 1 case. Only one complication occurred in 88 patients. Four patients had two complications. The incidence of perioperative complications was 17.59%(92/523 patients) in this series. The complication rate in different degenerative lumbar diseases was 17.53% in spondylolisthesis, 17.19% in lumbar stenosis, 14.52% in lumbar instability, 13.56% in massive lumbar disc herniation， 30.77% in revision surgery， 10.71% in degenerative disc diseases. There was no significant difference with respect to the incidence rate between one-level MIS-TLIF(17.53%) and two-level MIS-TLIF(18.42%)（χ2=0.02，P＞0.05）. Conclusions: MIS-TLIF is an effective technique for lumbar degenerative diseases. Perioperative complications include injuries to nerve roots, dural tear, wound infection and leg numbness. Transient leg numbness is the most common complication in this series.