微创与开放经椎间孔腰椎椎间融合术对比研究进展_《中国修复重建外科杂志》

作者：

苏锴 , 郭营 , 张忠民 , 金大地

南方医科大学第三附属医院骨科中心广东省骨科研究院（广州，510630）;

关键词：

经椎间孔腰椎椎间融合术微创手术开放手术对比研究

DOI：

10.7507/1002-1892.20130300

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

目的对微创与开放经椎间孔腰椎椎间融合术（transforaminal lumbar interbody fusion，TLIF）的对比研究进展进行综述。方法广泛查阅国内外近年来关于微创和开放TLIF对比研究的相关文献，分别从术中指标、住院时间、临床疗效、并发症、融合率和对椎旁肌影响5个方面进行分析总结。结果微创TLIF具有术中出血少、住院时间短等优点，但手术时间及透视时间较长。微创手术与开放手术均能获得较高的融合率，但微创手术的临床疗效并未优于开放手术，且并发症发生率相对较高。在肌酸激酶、多裂肌横截面积和萎缩分级上，微创手术未明显减少对椎旁肌的损伤。结论微创TLIF并未明显优于开放TLIF，也未明显减少对椎旁肌的损伤；二者疗效差异尚需前瞻性双盲随机对照试验进一步研究。

引用本文： 苏锴,郭营,张忠民,金大地. 微创与开放经椎间孔腰椎椎间融合术对比研究进展. 中国修复重建外科杂志, 2013, 27(11): 1386-1389. doi: 10.7507/1002-1892.20130300 复制

1.	Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg, 1953, 10(2): 154-168.
2.	Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg, 1956, 44(185): 266-275.
3.	Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am, 2002, 33(2): 359-366.
4.	Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
5.	Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2012, 21(11): 2265-2270.
6.	Schizas C, Tzinieris N, Tsiridis E, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop, 2009, 33(6): 1683-1688.
7.	Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385-1389.
8.	Villavicencio AT, Burneikiene S, Roeca CM, et al. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int, 2010, 1: 12.
9.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
10.	Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine, 2008, 9(6): 560-565.
11.	Epstein NE. How often is minimally invasive minimally effective: what are the complication rates for minimally invasive surgery? Surg Neurol, 2008, 70(4): 386-389.
12.	Ebata S, Sato H, Orii H, et al. Risk management in posterior spinal endoscopic surgery in lumbar diseases. J Orthop Sci, 2013, 18(3): 369-373.
13.	Wu RH, Fraser JF, Hartl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine (Phila Pa 1976), 2010, 35(26): 2273-2281.
14.	Kuriyama N, Ito H. Electromyographic functional analysis of the lumbar spinal muscles with low back pain. J Nippon Med Sch, 2005, 72(3): 165-173.
15.	Min SH, Kim MH, Seo JB, et al. The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J, 2009, 3(2): 89-95.
16.	Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976), 1997, 22(9): 1018-1023.
17.	Wang HL, Lu FZ, Jiang JY, et al. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J (Engl), 2011, 124(23): 3868-3874.
18.	Adogwa O, Johnson K, Min ET, et al. Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study. Surg Neurol Int, 2012, 3(Suppl 5): S355-361.
19.	Hu Y, Leung HB, Lu WW, et al. Histologic and electrophysiological changes of the paraspinal muscle after spinal fusion: an experimental study. Spine (Phila Pa 1976), 2008, 33(13): 1418-1422.
20.	Payer M. “Minimally invasive” lumbar spine surgery: a critical review. Acta Neurochir (Wien), 2011, 153(7): 1455-1459.
21.	Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl: S1-6.
22.	Dasenbrock HH, Juraschek SP, Schultz LR, et al. The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. J Neurosurg Spine, 2012, 16(5): 452-462.
23.	Epstein NE. Minimally invasive/endoscopic vs “open” posterior cervical laminoforaminotomy: do the risks outweigh the benefits? Surg Neurol, 2009, 71(3): 330-331.
24.	Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine (Phila Pa 1976), 1994, 19(22): 2598-2602.
25.	Gejo R, Matsui H, Kawaguchi Y, et al. Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976), 1999, 24(10): 1023-1028.
26.	Styf JR, Willen 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.
27.	Datta G, Gnanalingham KK, Peterson D, et al. Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction? Neurosurgery, 2004, 54(6): 1413-1420.
28.	Taylor H, Mcgregor AH, Medhi-Zadeh S, et al. The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine (Phila Pa 1976), 2002, 27(24): 2758-2762.

1. Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg, 1953, 10(2): 154-168.
2. Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg, 1956, 44(185): 266-275.
3. Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am, 2002, 33(2): 359-366.
4. Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976), 2003, 28(15 Suppl): S26-35.
5. Lee KH, Yue WM, Yeo W, et al. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2012, 21(11): 2265-2270.
6. Schizas C, Tzinieris N, Tsiridis E, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop, 2009, 33(6): 1683-1688.
7. Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385-1389.
8. Villavicencio AT, Burneikiene S, Roeca CM, et al. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int, 2010, 1: 12.
9. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
10. Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine, 2008, 9(6): 560-565.
11. Epstein NE. How often is minimally invasive minimally effective: what are the complication rates for minimally invasive surgery? Surg Neurol, 2008, 70(4): 386-389.
12. Ebata S, Sato H, Orii H, et al. Risk management in posterior spinal endoscopic surgery in lumbar diseases. J Orthop Sci, 2013, 18(3): 369-373.
13. Wu RH, Fraser JF, Hartl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine (Phila Pa 1976), 2010, 35(26): 2273-2281.
14. Kuriyama N, Ito H. Electromyographic functional analysis of the lumbar spinal muscles with low back pain. J Nippon Med Sch, 2005, 72(3): 165-173.
15. Min SH, Kim MH, Seo JB, et al. The quantitative analysis of back muscle degeneration after posterior lumbar fusion: comparison of minimally invasive and conventional open surgery. Asian Spine J, 2009, 3(2): 89-95.
16. Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976), 1997, 22(9): 1018-1023.
17. Wang HL, Lu FZ, Jiang JY, et al. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial. Chin Med J (Engl), 2011, 124(23): 3868-3874.
18. Adogwa O, Johnson K, Min ET, et al. Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study. Surg Neurol Int, 2012, 3(Suppl 5): S355-361.
19. Hu Y, Leung HB, Lu WW, et al. Histologic and electrophysiological changes of the paraspinal muscle after spinal fusion: an experimental study. Spine (Phila Pa 1976), 2008, 33(13): 1418-1422.
20. Payer M. “Minimally invasive” lumbar spine surgery: a critical review. Acta Neurochir (Wien), 2011, 153(7): 1455-1459.
21. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl: S1-6.
22. Dasenbrock HH, Juraschek SP, Schultz LR, et al. The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. J Neurosurg Spine, 2012, 16(5): 452-462.
23. Epstein NE. Minimally invasive/endoscopic vs “open” posterior cervical laminoforaminotomy: do the risks outweigh the benefits? Surg Neurol, 2009, 71(3): 330-331.
24. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans. Spine (Phila Pa 1976), 1994, 19(22): 2598-2602.
25. Gejo R, Matsui H, Kawaguchi Y, et al. Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976), 1999, 24(10): 1023-1028.
26. Styf JR, Willen 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.
27. Datta G, Gnanalingham KK, Peterson D, et al. Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction? Neurosurgery, 2004, 54(6): 1413-1420.
28. Taylor H, Mcgregor AH, Medhi-Zadeh S, et al. The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine (Phila Pa 1976), 2002, 27(24): 2758-2762.

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《中国修复重建外科杂志》

微创与开放经椎间孔腰椎椎间融合术对比研究进展

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