摘要
目的评价微创经椎间孔腰椎体间融合术（MIS—TLIF）和开放经椎间孔腰椎间融合术（TLIF）治疗单节段退变性腰椎管狭窄症的临床效果。方法自2009年1月～2011年3月，56例单节段退变性腰椎管狭窄症患者进行双侧METRxTMXTube辅助下MIS—TLIF或后路开放TLIF手术，采用X-Tube辅助扩张通道下MIS—TLIF治疗患者22例（MrS—TLIF组），传统开放TLIF方法治疗患者34例（TLIF组）。分析两组手术时间、手术出血量、术中X线照射时间、术后平均住院时间和并发症等方面的差异，采用视觉模拟评分（VAS）和Os—westry功能障碍指数（ODI）评分评估临床结果，行X线片评价椎间融合情况，术后末次随访时采用MacNab标准评价临床效果。结果所有患者均获得随访。两组术前一般资料，VAS和ODI评分无显著性差异。术后两组各出现1例硬膜囊撕裂，术后脑脊液漏，拔管后脑脊液漏即停止，无其他并发症发生，MIS—TLIF组手术时间和术中X线照射时间多于TLIF组（P〈0．01），手术出血量MIS—TLIF组明显低于TLIF组（P〈O．01）。术后平均住院日MIS—TLIF组明显短于TLIF组（P〈0．01）。术后两组vAs和ODI评分相比均无显著性差异（P〉0．05），术后X线评价融合率和末次随访临床效果优良率两组亦无显著性差异（P〉0．05）。结论与传统开放手术相比，X—Tube辅助下微创经椎间孔腰椎体间融合术治疗单节段退变性腰椎管狭窄症也可以获得相同的效果，并具有创伤小、恢复快的优点。
[Objective ] To evaluate the clinical outcomes of minimally invasive transforminal lumbar interbody fusion（MIS-TLIF） and open transforaminal lumbar interbody fusion （TLIF） for single-level degeneration lumbar stenosis. [Methods] From Jan 2009 to March 2011, 56 patients of single-level degeneration lumbar stenosis with MIS- TLIF under double side METRxTM X-Tube system and TLIF. There were 20 males and 36 females,the mean age was 53 years （range, 38-70years）. There were 22 patients who underwent minimally invasive transforminal lumbar interbody fusion by X-Tube system （MIS-TLIF）, 34 patients who underwent open transforaminal lumbar interbody fusion （TLIF）. The operative time, blood loss, X-ray exposure time,bed time and complications were compared between the two groups. Clinical outcome was assessed using the visual analog scale （VAS） and the Oswestry disability index （ODI）. Fusion rates were determined by X-ray examination and clinical outcomes were determined using Mac- Nab criterion in last fellow-up. [ Results ] All patients were followed up, there was no difference with respect to preoperative demographic date, VAS and ODI scores between two groups.There was 1 case complicated with dural tear in each group,which all were followed by cerebrospinal fluid leakage after operation and stop after extubation,and no other complications.MIS-TLIF group had longer operative time and X-ray exposure time than TLIF group （P 〈0.01）, but less operative blood loss than TLIF group （P 〈0.01）, MIS-TLIF group had shorter postoperative bed time than TLIF group （P 〈0.01）. There was no difference between two groups with VAS and ODI scores （P 〉0.05）, the same results with fusion rates and clinical outcomes in last fellow-up （P 〉0.05）. [ Conclusions ] Compared with regular opening way, minimally invasive transforminal lumbar interbody fusion under X-Tube system for single-level degeneration lumbar stenosis has the similar outcomes,but it can minimize tissue trauma and shorter recovery time.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2014年第21期54-59,共6页
China Journal of Modern Medicine
关键词
腰椎管狭窄症
微创性
外科手术
经椎间孔腰椎间融合术
Lumbar stenosis
Minimally invasive
surgical procedures
transforaminal lumbar interbody fusion
