中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
10期
1088-1092
,共5页
张海龙%顾昕%贺石生%顾广飞%张立国%丁悦%贾建波%周旭%袁超群%李佳怡%袁嘉敏
張海龍%顧昕%賀石生%顧廣飛%張立國%丁悅%賈建波%週旭%袁超群%李佳怡%袁嘉敏
장해룡%고흔%하석생%고엄비%장입국%정열%가건파%주욱%원초군%리가이%원가민
腰椎%脊椎滑脱%外科手术,微创性
腰椎%脊椎滑脫%外科手術,微創性
요추%척추활탈%외과수술,미창성
Lumbar vertebrae%Spondylolysis%Surgical procedures,minimally invasive
目的 对比分析微创经椎间孔椎体间融合术(mini-open transforaminal lumbar interbody fusion,mini-TLIF)与常规开放手术治疗腰椎滑脱症的疗效.方法 回顾性分析2008年3月至2010年8月手术治疗的49例腰椎滑脱症患者,开放手术组26例,mini-TLIF手术组23例.分别统计两组的手术时间、术中出血量、透视时间、手术前后疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI).根据Macnab标准观察临床疗效,测量两组手术前后的各放射学参数并进行对比分析.结果 患者随访9～22个月,平均11个月.手术出血量、术后2天与3个月VAS、患者再次手术意愿等指标mini-TLIF手术组均优于开放手术组,且差异有统计学意义(P＜0.05);开放手术组ODI由术前的31.2％±8.2％降至术后末次随访时的16.1％±6.8％,差值为17.8％±4.2％;微创手术组ODI由术前的34.4％±11.7％降至末次随访时的15.3％±4.3％,差值为19.7％±3.8％,两组的手术前后ODI差值差异无统计学意义(t=0.673,P=0.412);两组手术时间、透视时间,微创手术组均明显长于开放手术组,且差异有统计学意义(P＜0.05).结论 与常规开放手术相比较,mini-TLIF治疗腰椎滑脱症术中出血较少,术后疼痛轻,但需要较长时间的手术及术者接受较多的放射线暴露.
目的 對比分析微創經椎間孔椎體間融閤術(mini-open transforaminal lumbar interbody fusion,mini-TLIF)與常規開放手術治療腰椎滑脫癥的療效.方法 迴顧性分析2008年3月至2010年8月手術治療的49例腰椎滑脫癥患者,開放手術組26例,mini-TLIF手術組23例.分彆統計兩組的手術時間、術中齣血量、透視時間、手術前後疼痛視覺模擬評分(visual analogue scale,VAS)、Oswestry功能障礙指數(Oswestry disability index,ODI).根據Macnab標準觀察臨床療效,測量兩組手術前後的各放射學參數併進行對比分析.結果 患者隨訪9～22箇月,平均11箇月.手術齣血量、術後2天與3箇月VAS、患者再次手術意願等指標mini-TLIF手術組均優于開放手術組,且差異有統計學意義(P＜0.05);開放手術組ODI由術前的31.2％±8.2％降至術後末次隨訪時的16.1％±6.8％,差值為17.8％±4.2％;微創手術組ODI由術前的34.4％±11.7％降至末次隨訪時的15.3％±4.3％,差值為19.7％±3.8％,兩組的手術前後ODI差值差異無統計學意義(t=0.673,P=0.412);兩組手術時間、透視時間,微創手術組均明顯長于開放手術組,且差異有統計學意義(P＜0.05).結論 與常規開放手術相比較,mini-TLIF治療腰椎滑脫癥術中齣血較少,術後疼痛輕,但需要較長時間的手術及術者接受較多的放射線暴露.
목적 대비분석미창경추간공추체간융합술(mini-open transforaminal lumbar interbody fusion,mini-TLIF)여상규개방수술치료요추활탈증적료효.방법 회고성분석2008년3월지2010년8월수술치료적49례요추활탈증환자,개방수술조26례,mini-TLIF수술조23례.분별통계량조적수술시간、술중출혈량、투시시간、수술전후동통시각모의평분(visual analogue scale,VAS)、Oswestry공능장애지수(Oswestry disability index,ODI).근거Macnab표준관찰림상료효,측량량조수술전후적각방사학삼수병진행대비분석.결과 환자수방9～22개월,평균11개월.수술출혈량、술후2천여3개월VAS、환자재차수술의원등지표mini-TLIF수술조균우우개방수술조,차차이유통계학의의(P＜0.05);개방수술조ODI유술전적31.2％±8.2％강지술후말차수방시적16.1％±6.8％,차치위17.8％±4.2％;미창수술조ODI유술전적34.4％±11.7％강지말차수방시적15.3％±4.3％,차치위19.7％±3.8％,량조적수술전후ODI차치차이무통계학의의(t=0.673,P=0.412);량조수술시간、투시시간,미창수술조균명현장우개방수술조,차차이유통계학의의(P＜0.05).결론 여상규개방수술상비교,mini-TLIF치료요추활탈증술중출혈교소,술후동통경,단수요교장시간적수술급술자접수교다적방사선폭로.
Objective To compare the clinical results between minimally invasive transforaminal lumbar (mini-TLIF) and posterior open surgery in treatment of lumbar spondylolisthesis.Methods From March 2008 to August 2010,a total of 49 cases with lumbar spondylolisthesis underwent surgical intervention were retrospectively analyzed,including 23 cases with mini-TLIF and 26 with open surgery.Operation time,intra-operative bleeding,and radiation exposure times were recorded.Pre- and postoperative back pain was assessed by visual analogue scale(VAS),and lumbar function was evaluated by Oswestry disability index (ODI).The clinical results were assessed by Macnab criterion,and the pre and postoperative radiologic parameters were compared.Results The mean follow-up time was 11 months (ranged,9-22).Both groups got good clinical results and satisfactory radiologic parameters.The group of mini-TLIF was superior to the group of open surgery in intra-operative bleeding,VAS of the second day postoperatively and the willingness of reoperation (P＜0.05).The ODI in the patients with open surgery were decreased from 31.2％±8.2％ to 16.1％±6.8％ corresponding to the pre-oporation and the final follow-up.The ODI in the patients with mini-TLIF were decreased from 34.4％±11.7％ to 15.3％±4.3％ corresponding to the pre-operation and the final follow-up.There is no significant difference of the change of ODI between two groups (t=0.673,P=0.412).The group of mini-TLIF need more operation time and were exposed to more X-ray when compared to the open surgery group (P＜0.05).Conclusion Mini-TLIF and open surgery can both get satisfactory clinical outcomes in treatment of lumbar spondylolisthesis.Mini-TLIF was superior to open surgery in intra-operative bleeding and VAS of the second day postoperatively,but it needs more operation time and radiation exposure.
