摘要
目的通过与经椎间孔入路椎间融合术(TLIF)比较,探讨显微目镜辅助Quadrant通道下微创经椎间孔入路椎间融合术(MIS TLIF)治疗腰椎退变性疾病的临床疗效。方法回顾性分析2015年1月至2017年12月安徽医科大学附属六安医院收治的腰椎退变性疾病病人87例,按手术方法分为MIS TLIF组(40例)和TLIF组(47例)。MIS TLIF组采用Quadrant可扩张通道联合目镜下直视技术。比较两组病人的围手术期及随访资料,采用视觉模拟评分(Visual Analogue Scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评价两组病人的腰痛及下肢痛情况。采用影像学动态X片评价椎间融合情况。结果87例病人均顺利完成手术,无明显并发症。MIS TLIF组手术时间(97.33±5.413)min长于TLIF组(81.36±5.054)min,术中透视次数(6.15±0.86)次多于TLIF组(4.26±0.71)次,差异有统计学意义(t=14.211,11.257,均P<0.001);MIS TLIF组术中出血量及术后引流量少于TLIF组,且术后下地时间和住院时间少于TLIF组,差异有统计学意义(t=-37.458,-16.923,-16.220,-8.299,均P<0.001);两组病人术后腰痛、下肢痛VAS评分及ODI评分均较术前明显降低,差异有统计学意义(均P<0.01);术后3 d MIS TLIF组腰痛缓解明显优于TLIF组[VAS(1.80±0.61)比(3.01±0.68)分],差异有统计学意义(P<0.001);术后3 d下肢痛VAS评分、术后1年腰痛、下肢痛VAS评分差异无统计学意义(均P>0.05);术后1月、术后1年ODI评分差异无统计学意义(均P>0.05),其中术后1月ODI评分差异无统计学意义(P=0.064)。结论采用显微目镜辅助通道下MIS TLIF技术治疗腰椎退变性疾病可以达到与TLIF手术相同的疗效,且创伤更小,卧床时间更短,术后病人腰痛缓解更显著,有利于病人恢复及早期功能锻炼,契合加速康复外科(ERAS)理念。
Objective To evaluate the clinical efficacy of minimally invasive interbody fusion(MIS TLIF)in the treatment of lum bar degenerative diseases by comparing the(TLIF)with the transforaminal interbody fusion(TLIF)via the Quadrant channel un der microscope and eyepiece assisted minimally invasive interbody fusion(MIS TLIF)in the treatment of lumbar degenerative dis eases.Methods 87 patients with lumbar degenerative diseases admitted in our hospital from January 2015 to December 2017 were retrospectively analyzed.The patients were divided into MIS TLIF group(n=40)and TLIF group(n=47)according to the opera tion method.The patients in the MIS TLIF group were treated with Quadrant expandable channel combined with eyepiece direct vi sion technique.The perioperative and follow up data of the two groups were compared.Visual analogue score(Visual Analogue Scale,VAS)and Oswestry dysfunction index(Oswestry disability i)were used.Ndex,ODI was used to evaluate the low back pain and lower limb pain in the two groups.Dynamic X ray imaging was used to evaluate interbody fusion.Results 87 patients success fully completed the operation without obvious complications.The mean operative time in the MIS TLIF group(97.33±5.413)min was longer than that in the TLIF group(81.36±5.054)min,and the times of intraoperative fluoroscopy(6.15±0.86)times were more than those in the TLIF group(4.26±0.71)times,the differences were statistically significant(t=14.211,11.257,all P<0.001).The intraoperative bleeding volume and postoperative drainage volume in the MIS TLIF group were less than those in the TLIF group,and the duration of operation and hospitalization in the TLIF group were less than those in the TLIF group.The differ ence was statistically significant(t=37.458,16.923,16.220,8.299,P<0.001).VAS score and ODI score of postoperative lower back pain and lower limb pain in the two groups were significantly lower than those before surgery,with statistically significant differences(all P<0.01).The relief of lumbago in the MIS TLIF group was significantly better than that in the TLIF group on the 3rd day after surgery[VAS(1.80±0.61)vs.(3.01±0.68)],the difference was statistically significant(P<0.001).There was no signifi cant difference in VAS scores of lower limb pain 3 days after surgery,lower back pain and lower limb pain 1 year after surgery(all P>0.05).There was no significant difference in ODI scores between 1 month and 1 year after surgery(P>0.05).There was no sig nificant difference in ODI scores at 1 month postoperatively(P=0.064).Conclusion the treatment of lumbar degenerative diseas es with MIS TLIF under microscope eyepiece can achieve the same curative effect as TLIF operation,and the trauma is less,the du ration of stay in bed is shorter,and the patients’lumbago relief is more remarkable after operation.It is beneficial to patients’re covery and early functional exercise,which is consistent with the concept of accelerated rehabilitation surgery(ERAS).
作者
杨长青
邵松
YANG Changqing;SHAO Song(Department of Orthopedics,Lu’an Hospital of Anhui Medical University,Lu’an,Anhui 237005,China)
出处
《安徽医药》
CAS
2020年第5期915-920,共6页
Anhui Medical and Pharmaceutical Journal
基金
安徽省卫生和计划生育委员会科研计划项目(2016QK042)。
关键词
脊柱疾病
脊柱融合术
外科手术
微创性
显微目镜
加速康复外科
Spinal diseases
Spinal fusion
Surgical procedures,minimally invasive
Microscopic eyepiece
Enhanced re covery after surgery
