单侧切口微创经椎间孔腰椎椎间融合术混合内固定治疗双节段腰椎退行性疾病_《中国修复重建外科杂志》

作者：

徐教 , 毛克亚 , 王岩 , 肖嵩华 , 李鹏 , 毛克政 , 肖波 , 王义国

解放军总医院骨科（北京，100853）;

关键词：

微创经椎间孔腰椎椎间融合术单侧切口混合内固定双节段腰椎退行性疾病

DOI：

10.7507/1002-1892.20130208

视频：

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目的探讨采用单侧切口微创经椎间孔腰椎椎间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）以椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定治疗双节段腰椎退行性疾病的可行性及临床疗效。方法2010年1月－2012年1月，收治19例双节段腰椎退行性疾病患者。男7例，女12例；年龄22～68岁，平均50.4岁。病程8个月～15年，中位病程37个月。手术节段：L3～5 6例，L4～S1 13例。在单侧切口工作通道下完成MIS-TLIF手术，采用椎弓根螺钉结合对侧经椎板关节突螺钉双侧混合内固定。结果患者均顺利完成手术，平均手术时间158 min、术中出血量156 mL、切口长度42 mm、术后下地时间35 h、住院时间4.1 d、经椎板关节突螺钉长度51 mm。术后切口均Ⅰ期愈合；除1例术中硬膜撕裂外，未出现其他并发症。19例均获随访，随访时间12～24个月，平均17.1个月。术后各时间点腰痛视觉模拟评分（VAS）、腿痛VAS评分及Oswestry功能障碍指数（ODI）评分均较术前显著改善（P lt; 0.05）；且随时间延长症状逐渐缓解。术后X线片示内固定物位置良好，经椎板关节突螺钉均穿过棘突根部、椎板和关节突关节，其中2枚（5.3%）经椎板关节突螺钉穿透椎板外侧皮质，1枚（1.8%）椎弓根螺钉略偏出椎弓根外，但均无神经损伤症状。术后12个月CT平扫及三维重建显示椎体间骨性融合良好；根据Bridwell椎间融合评价标准评价，Ⅰ级11例，Ⅱ级8例。结论采用单侧切口MIS-TLIF混合内固定治疗双节段腰椎退行性疾病安全可行，具有手术时间短、创伤小、出血少及恢复快等优点。

引用本文： 徐教,毛克亚,王岩,肖嵩华,李鹏,毛克政,肖波,王义国. 单侧切口微创经椎间孔腰椎椎间融合术混合内固定治疗双节段腰椎退行性疾病. 中国修复重建外科杂志, 2013, 27(8): 955-959. doi: 10.7507/1002-1892.20130208 复制

1.	Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
2.	Lau D, Lee JG, Han SJ, et al. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci, 2011, 18(5): 624-627.
3.	Fan SW, Zhao X, Zhao FD, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
4.	毛克亚, 王岩, 肖嵩华, 等. 单侧微创经椎间孔腰椎体间融合术采用椎弓根螺钉结合经椎板关节突螺钉混合内固定可行性研究. 中华外科杂志, 2011, 49(12): 1067-1070.
5.	Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects. Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
6.	Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6): 712-716．.
7.	Tsutsumimoto T, Shimogata M, Ohta H, et al. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine (Phila Pa 1976), 2009, 34(18): 1923-1928.
8.	Fritzell P, Hagg O, Wessberg P, et al. Chronic low back pain and fusion: a comparison of three surgical technique. A prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976), 2002, 27(11): 1131-1141.
9.	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, 2007, 7(3): 282-286．.
10.	范顺武, 胡志军, 方向前, 等. 小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究. 中华骨科杂志, 2009, 29(11): 1000-1004.
11.	毛克亚, 王岩, 肖嵩华, 等. 直视下微创与切开进行单节段经椎间孔腰椎融合术的临床效果比较. 中国矫形外科杂志, 2012, 20(9): 769-773.
12.	Suk KS, Lee HM, Kim NH, et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine (Phila Pa 1976), 2000, 25(14): 1843-1847．.
13.	Beringer WF, Mobasser JP. Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3): E4．.
14.	Slucky AV, Brodke DS, Bachus KN, et al. Less invasive posterior fixation method following transforaminal lumbar interbody fusion: a biomechanical analysis. Spine J , 2006, 6(1): 78-85.
15.	Scarone P, Lepeintre JF, Bennis S, et al. Two-levels mini-open transforaminal lumbar interbody fusion: technical note. Minim Invasive Neurosurg, 2009, 52(5-6): 275-280.
16.	黎庆初, 尹刚辉, 张忠民, 等. 微创Wiltse入路与传统后正中入路手术治疗双节段腰椎管狭窄症的疗效比较. 中国脊柱脊髓杂志, 2012, 22(9): 812-817.
17.	陆声, 徐永清, 丁自海, 等. 经皮椎板关节突螺钉固定的应用解剖及影像学研究. 中国矫形外科杂志, 2006, 14(5): 351-352.
18.	Jang JS, Lee SH, Lim SR. Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion Technical note. J Neurosurg, 2003, 98(1 Suppl): 100-103.

1. Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
2. Lau D, Lee JG, Han SJ, et al. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci, 2011, 18(5): 624-627.
3. Fan SW, Zhao X, Zhao FD, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
4. 毛克亚, 王岩, 肖嵩华, 等. 单侧微创经椎间孔腰椎体间融合术采用椎弓根螺钉结合经椎板关节突螺钉混合内固定可行性研究. 中华外科杂志, 2011, 49(12): 1067-1070.
5. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects. Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
6. Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6): 712-716．.
7. Tsutsumimoto T, Shimogata M, Ohta H, et al. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine (Phila Pa 1976), 2009, 34(18): 1923-1928.
8. Fritzell P, Hagg O, Wessberg P, et al. Chronic low back pain and fusion: a comparison of three surgical technique. A prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976), 2002, 27(11): 1131-1141.
9. 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, 2007, 7(3): 282-286．.
10. 范顺武, 胡志军, 方向前, 等. 小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究. 中华骨科杂志, 2009, 29(11): 1000-1004.
11. 毛克亚, 王岩, 肖嵩华, 等. 直视下微创与切开进行单节段经椎间孔腰椎融合术的临床效果比较. 中国矫形外科杂志, 2012, 20(9): 769-773.
12. Suk KS, Lee HM, Kim NH, et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine (Phila Pa 1976), 2000, 25(14): 1843-1847．.
13. Beringer WF, Mobasser JP. Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3): E4．.
14. Slucky AV, Brodke DS, Bachus KN, et al. Less invasive posterior fixation method following transforaminal lumbar interbody fusion: a biomechanical analysis. Spine J , 2006, 6(1): 78-85.
15. Scarone P, Lepeintre JF, Bennis S, et al. Two-levels mini-open transforaminal lumbar interbody fusion: technical note. Minim Invasive Neurosurg, 2009, 52(5-6): 275-280.
16. 黎庆初, 尹刚辉, 张忠民, 等. 微创Wiltse入路与传统后正中入路手术治疗双节段腰椎管狭窄症的疗效比较. 中国脊柱脊髓杂志, 2012, 22(9): 812-817.
17. 陆声, 徐永清, 丁自海, 等. 经皮椎板关节突螺钉固定的应用解剖及影像学研究. 中国矫形外科杂志, 2006, 14(5): 351-352.
18. Jang JS, Lee SH, Lim SR. Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion Technical note. J Neurosurg, 2003, 98(1 Suppl): 100-103.

《中国修复重建外科杂志》

单侧切口微创经椎间孔腰椎椎间融合术混合内固定治疗双节段腰椎退行性疾病

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《中国修复重建外科杂志》

单侧切口微创经椎间孔腰椎椎间融合术混合内固定治疗双节段腰椎退行性疾病

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