微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较_《中国修复重建外科杂志》

作者：

杨进 , 孔清泉 , 宋跃明 , 刘浩 , 曾建成

四川大学华西医院骨科（成都，610041）;

关键词：

单节段腰椎退变疾患经椎间孔腰椎椎间融合术微创手术开放手术

DOI：

10.7507/1002-1892.20130061

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的比较微创小切口经椎间孔腰椎椎间融合术（minimally invasive surgery-transforaminal lumbar interbody fusion，MIS-TLIF）与传统开放TLIF（open-TLIF）治疗单节段腰椎退变疾患的近期疗效。方法回顾分析2010年2月－2011年2月收治且符合选择标准的单节段腰椎退变疾患患者临床资料，其中43例采用MIS-TLIF治疗（MIS-TLIF组），104例采用open-TLIF治疗（open-TLIF组）。两组患者性别、年龄、病变类型、病变节段、病程、术前疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）比较，差异均无统计学意义（P gt; 0.05），具有可比性。比较两组手术时间、术中透视时间、术中及术后出血量、术后住院时间及术后并发症发生情况，行VAS及ODI评分，影像学检查评价植骨融合情况、内固定物以及Cage位置。结果两组手术时间相似（t=0.402，P=0.688）；与open-TLIF组相比，MIS-TLIF组术中及术后出血量降低，术后住院时间缩短，但术中透视时间延长，差异均有统计学意义（P lt; 0.05）。术后open-TLIF组出现2例脑脊液漏， 2例切口浅表感染，并发症发生率为3.8%（4/104）；MIS-TLIF组出现3例背根神经节激惹症状，并发症发生率为7.0%（3/43）；两组并发症发生率比较，差异无统计学意义（χ2=0.657，P=0.417）。两组患者术后均获随访，MIS-TLIF组随访时间18～26个月，平均21个月；open-TLIF组18～28个月，平均23个月。术后各时间点两组患者VAS评分及ODI均较术前显著改善（P lt; 0.05）。术后出院时及3个月，两组VAS评分比较差异均无统计学意义（P gt; 0.05）；末次随访时，MIS-TLIF组VAS评分显著低于open-TLIF组（t= —2.022，P=0.047）。术后3个月及末次随访时，两组间ODI比较差异均无统计学意义（P gt; 0.05）。影像学检查显示，随访期间两组Cage和内固定物位置良好，植骨均融合。结论MIS-TLIF治疗单节段腰椎退变疾患近期疗效与open-TLIF相当，同时具有手术创伤小、术后恢复快的优点，但远期疗效需进一步观察。

引用本文： 杨进,孔清泉,宋跃明,刘浩,曾建成. 微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较. 中国修复重建外科杂志, 2013, 27(3): 262-267. doi: 10.7507/1002-1892.20130061 复制

1.	11 Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 2004, 1(1): 24-30. 12 Holly LT, Schwender JD, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus, 2006, 20(3): E6. 13 Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261. 14 蒋淳, 姜小幸, 冯振洲, 等. 单侧置钉经椎间孔椎体融合术结合经椎板的关节突螺钉治疗退行性腰椎疾病. 中华临床医学, 2010, 17(6): 856-858.
2.	15 Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci, 2012, 19(1): 111-114. 16 O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine, 2009, 11(4): 471-476.
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7.	Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
8.	Styf JR, Willén 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.
9.	Lee SH, Choi WG, Lim SR, et al. Minimally invasive anterior lumbar interody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis. Spine J, 2004, 4(6): 644-649.
10.	Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
11.	Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976), 2001, 26(5): 567-571.
12.	Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg, 2002, 49: 499-517.
13.	Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50(5): 919-926.
14.	Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-years clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
15.	Fessler RG. Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery, 2003, 52(6): 1512.
16.	Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg, 2002, 97(1 Suppl): 7-12.

1. 11 Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 2004, 1(1): 24-30. 12 Holly LT, Schwender JD, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus, 2006, 20(3): E6. 13 Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261. 14 蒋淳, 姜小幸, 冯振洲, 等. 单侧置钉经椎间孔椎体融合术结合经椎板的关节突螺钉治疗退行性腰椎疾病. 中华临床医学, 2010, 17(6): 856-858.
2. 15 Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci, 2012, 19(1): 111-114. 16 O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine, 2009, 11(4): 471-476.
3.
4.
5.
6.
7. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
8. Styf JR, Willén 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.
9. Lee SH, Choi WG, Lim SR, et al. Minimally invasive anterior lumbar interody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis. Spine J, 2004, 4(6): 644-649.
10. Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
11. Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976), 2001, 26(5): 567-571.
12. Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg, 2002, 49: 499-517.
13. Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50(5): 919-926.
14. Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-years clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
15. Fessler RG. Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery, 2003, 52(6): 1512.
16. Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg, 2002, 97(1 Suppl): 7-12.

《中国修复重建外科杂志》

微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较

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《中国修复重建外科杂志》

微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较

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