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自制微创拉钩辅助改良双侧Wiltse入路经椎间孔椎体间融合术在腰椎退行性病变治疗中的应用 被引量:8

Clinical application of self-made minimally invasive hood-assisted transforaminal lumbar interbody fusion via modified bilateral Wiltse approach in the treatment of lumbar degenerative diseases
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摘要 目的:探讨自制微创拉钩辅助改良双侧Wiltse入路经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)在治疗腰椎退行性病变中的优势。方法:回顾性分析2016年10月至2017年10月行腰椎融合手术的140例患者的临床资料,其中72例患者采用自制微创拉钩辅助改良双侧Wiltse入路TLIF治疗(A组),男37例,女35例,年龄(48±16)岁;68例采用传统后正中入路TLIF治疗(B组),男38例,女30例,年龄(45±15)岁。记录两组患者的手术切口大小、手术时间、术中出血量、术后引流量、术后伤口愈合情况及末次随访椎间融合率,并采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)对两组患者的临床疗效进行评定。结果:所有患者获得随访,时间3~13(8±5)个月。A组患者术后伤口愈合良好,B组术后发生伤口坏死1例,经清创缝合后痊愈。两种手术方式在手术时间、术后融合率方面差异无统计学意义(P>0.05);A组在手术切口大小、术中出血量、术后引流量方面有明显优势(P<0.05),且术后的腰腿痛VAS评分及ODI均优于B组(P<0.05)。结论:自制微创拉钩辅助改良双侧Wiltse入路TLIF在治疗腰椎退行性病变中具有微创、术中出血量少、术后引流少、并发症少、融合稳定等特点。 Objective:To explore the advantages of self-made minimally invasive hook-assisted transforaminal lumbar interbody fusion(TLIF)via modified bilateral Wiltse approach in the treatment of lumbar degenerative diseases.Methods:The clinical data of 140 patients underwent lumbar spine fusion surgery from October 2016 to October 2017 were retrospectively analyzed.Among them,72 cases were treated by self-made minimally invasive hook-assisted TLIF via modified bilateral Wiltse approach(group A),there were 37 males and 35 females,aged(48±16)years old;68 cases were treated by TLIF via traditional posterior median approach(group B),there were 38 males and 30 females,aged(45±15)years old.The surgical incision size,operation time,intraoperative blood loss volume,postoperative drainage volume,postoperative wound healing,and intervertebral fusion rate at the final follow-up were recorded between two groups.Visual analogue scale(VAS)and Oswestry Disability Index(ODI)were used to assess the clinical efficacy.Results:All the patients were followed up for 3 to 13(8±5)months.The wound in group A healed well after operation,and 1 case in group B occurred wound necrosis after operation,and healed after debridement and suture.There were no significant differences in operation time and postoperative fusion rate between two surgical methods(P>0.05).Group A had obvious advantages in surgical incision size,intraoperative blood loss volume and postoperative drainage volume(P<0.05),and the postoperative VAS score of low back pain and ODI were better than group B(P<0.05).Conclusion:The self-made minimally invasive hook-assisted TLIF via modified bilateral Wiltse approach has the characteristics of minimally invasive,less intraoperative blood loss,less postoperative drainage,fewer complications,and more stable fusion in the treatment of lumbar degenerative desease.
作者 谷艳超 朱凌 胡胜利 谢维 吉璐宏 严浩 陈旺 GU Yan-chao;ZHU Ling;HU Sheng-li;XIE Wei;JI Lu-hong;YAN Hao;CHEN Wang(Hubei 672 Integrated Chinese and Western Medicine Orthopaedics Hospital,Wuhan 430000,Hubei,China)
出处 《中国骨伤》 CAS CSCD 2021年第4期297-303,共7页 China Journal of Orthopaedics and Traumatology
关键词 椎间盘退行性变 手术操作 脊柱融合术 Intervertebral disc degeneration Operative procedures Spinal fusion
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