中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
30期
5452-5459
,共8页
丁茹虎%刘波%张波%王永庆%肖斌%苏海涛
丁茹虎%劉波%張波%王永慶%肖斌%囌海濤
정여호%류파%장파%왕영경%초빈%소해도
骨关节植入物%脊柱植入物%腰椎间盘突出症%三维导航%微创%椎间融合%疼痛目测类比评分%腰椎疾患疗效评分%单节段%内固定
骨關節植入物%脊柱植入物%腰椎間盤突齣癥%三維導航%微創%椎間融閤%疼痛目測類比評分%腰椎疾患療效評分%單節段%內固定
골관절식입물%척주식입물%요추간반돌출증%삼유도항%미창%추간융합%동통목측류비평분%요추질환료효평분%단절단%내고정
bone and joint implants%spinal implants%lumbar disc herniation%three-dimensional navigation%minimally invasive%interbody fusion%visual analogue scale%Japanese Orthopaedic Association score%single-level%internal fixation
背景：导航辅助微创腰椎后路椎弓根螺钉及椎间融合器内固定可以实时精确引导微创套筒下各种操作，安全准确置入椎弓根螺钉及椎间融合器等各种内置物，并可以确定减压部位。微创经椎间孔椎间融合是近年来微创脊柱外科技术成功应用的典型代表，具有切口小、出血少、组织损伤轻和恢复快等显著优点。目的：评价即时三维导航下单节段微创经椎间孔椎间融合与开放后路椎间融合的短期临床疗效比较。方法：回顾性分析40例单节段腰椎间盘突出症患者资料，40例患者分别采用即时三维导航下微创经椎间孔椎间融合(20例)和开放后路椎间融合(20例)术式进行对比研究。比较两组融合时间、融合过程中出血量、融合后引流量、治疗后住院时间与总住院时间，疼痛目测类比评分和腰椎疾患疗效评分、治疗后伤口疼痛及功能情况。结果与结论：40例均获得平均7.7个月随访，微创经椎间孔椎间融合组平均手术时间较开放后路椎间融合组长，差异有非常显著性意义(P<0.01)，微创经椎间孔椎间融合组总的住院时间、治疗后住院时间较开放后路椎间融合组缩明显缩短，差异有非常显著性意义(P<0.01)；微创经椎间孔椎间融合过程中出血量明显较开放后路椎间融合减少，差异有显著性意义(P<0.05)；治疗后引流量也明显少于开放后路椎间融合组，差异有非常显著性意义(P<0.01)；与后路椎间融合组比较，内固定后3 d微创经椎间孔椎间融合组腰痛疼痛目测类比评分明显降低，腰椎疾患疗效评分明显升高，差异均有非常显著性意义(P<0.01)；但治疗前、治疗后6个月两组腰、腿痛疼痛目测类比评分和腰椎疾患疗效评分比较，差异无显著性意义(P>0.05)。说明即时三维导航下单节段微创经椎间孔椎间融合具有术中出血量少、治疗后引流少、创伤小、住院时间短、短期疗效确切等优点，是一种有效的治疗方法。
揹景：導航輔助微創腰椎後路椎弓根螺釘及椎間融閤器內固定可以實時精確引導微創套筒下各種操作，安全準確置入椎弓根螺釘及椎間融閤器等各種內置物，併可以確定減壓部位。微創經椎間孔椎間融閤是近年來微創脊柱外科技術成功應用的典型代錶，具有切口小、齣血少、組織損傷輕和恢複快等顯著優點。目的：評價即時三維導航下單節段微創經椎間孔椎間融閤與開放後路椎間融閤的短期臨床療效比較。方法：迴顧性分析40例單節段腰椎間盤突齣癥患者資料，40例患者分彆採用即時三維導航下微創經椎間孔椎間融閤(20例)和開放後路椎間融閤(20例)術式進行對比研究。比較兩組融閤時間、融閤過程中齣血量、融閤後引流量、治療後住院時間與總住院時間，疼痛目測類比評分和腰椎疾患療效評分、治療後傷口疼痛及功能情況。結果與結論：40例均穫得平均7.7箇月隨訪，微創經椎間孔椎間融閤組平均手術時間較開放後路椎間融閤組長，差異有非常顯著性意義(P<0.01)，微創經椎間孔椎間融閤組總的住院時間、治療後住院時間較開放後路椎間融閤組縮明顯縮短，差異有非常顯著性意義(P<0.01)；微創經椎間孔椎間融閤過程中齣血量明顯較開放後路椎間融閤減少，差異有顯著性意義(P<0.05)；治療後引流量也明顯少于開放後路椎間融閤組，差異有非常顯著性意義(P<0.01)；與後路椎間融閤組比較，內固定後3 d微創經椎間孔椎間融閤組腰痛疼痛目測類比評分明顯降低，腰椎疾患療效評分明顯升高，差異均有非常顯著性意義(P<0.01)；但治療前、治療後6箇月兩組腰、腿痛疼痛目測類比評分和腰椎疾患療效評分比較，差異無顯著性意義(P>0.05)。說明即時三維導航下單節段微創經椎間孔椎間融閤具有術中齣血量少、治療後引流少、創傷小、住院時間短、短期療效確切等優點，是一種有效的治療方法。
배경：도항보조미창요추후로추궁근라정급추간융합기내고정가이실시정학인도미창투통하각충조작，안전준학치입추궁근라정급추간융합기등각충내치물，병가이학정감압부위。미창경추간공추간융합시근년래미창척주외과기술성공응용적전형대표，구유절구소、출혈소、조직손상경화회복쾌등현저우점。목적：평개즉시삼유도항하단절단미창경추간공추간융합여개방후로추간융합적단기림상료효비교。방법：회고성분석40례단절단요추간반돌출증환자자료，40례환자분별채용즉시삼유도항하미창경추간공추간융합(20례)화개방후로추간융합(20례)술식진행대비연구。비교량조융합시간、융합과정중출혈량、융합후인류량、치료후주원시간여총주원시간，동통목측류비평분화요추질환료효평분、치료후상구동통급공능정황。결과여결론：40례균획득평균7.7개월수방，미창경추간공추간융합조평균수술시간교개방후로추간융합조장，차이유비상현저성의의(P<0.01)，미창경추간공추간융합조총적주원시간、치료후주원시간교개방후로추간융합조축명현축단，차이유비상현저성의의(P<0.01)；미창경추간공추간융합과정중출혈량명현교개방후로추간융합감소，차이유현저성의의(P<0.05)；치료후인류량야명현소우개방후로추간융합조，차이유비상현저성의의(P<0.01)；여후로추간융합조비교，내고정후3 d미창경추간공추간융합조요통동통목측류비평분명현강저，요추질환료효평분명현승고，차이균유비상현저성의의(P<0.01)；단치료전、치료후6개월량조요、퇴통동통목측류비평분화요추질환료효평분비교，차이무현저성의의(P>0.05)。설명즉시삼유도항하단절단미창경추간공추간융합구유술중출혈량소、치료후인류소、창상소、주원시간단、단기료효학절등우점，시일충유효적치료방법。
BACKGROUND:Navigation assisted minimal y invasive posterior lumbar interbody fusion and pedicle screw fixation can precisely real-time guide a variety of operation under minimal y invasive sleeve, and implant the pedicle screws and interbody fusion cage and other implants safely and accurately, thus can determine the decompression parts. Minimal y invasive transforaminal lumbar interbody fusion is the typical approach in recent years for the successful application of minimal y invasive spine surgery techniques with the advantages of smal incision, less bleeding, slight tissue damage and faster recovery. OBJECTIVE:To evaluate the short-term effect of minimal y invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system and open posterior transforaminal lumbar interbody fusion. METHODS:Forty cases with single-level lumbar disc herniation were retrospectively analyzed. The patients were treated with minimal y invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system (20 cases) and open posterior transforaminal lumbar interbody fusion (20 cases) respectively for the comparative analysis. The fusion duration, intraoperative blood loss, postoperative drainage volume, the length of postoperative hospital stay and the length of hospital stay were compared between two groups. The wound pain and function were evaluated after treatment with visual analogue scale score and Japanese Orthopaedic Association score. RESULTS AND CONCLUSION:Al patients were fol owed-up for 7.7 months. The operative duration in the minimal y invasive transforaminal lumbar interbody fusion group was longer than that in the open posterior transforaminal lumbar interbody fusion group, and the difference was significant (P<0.01);the length of hospital stay and length of postoperative hospital stay of the minimal y invasive transforaminal lumbar interbody fusion group were shorter than the open posterior transforaminal lumbar interbody fusion group, and the differences were significant (P<0.01);the intraoperative blood loss of the minimal y invasive transforaminal lumbar interbody fusion group was less than the open posterior transforaminal lumbar interbody fusion group, and the difference was significant (P<0.05);the postoperative drainage volume of the minimal y invasive transforaminal lumbar interbody fusion group was less than the open posterior transforaminal lumbar interbody fusion group, and the difference was significant (P<0.01). The visual analogue scale score was significantly decreased and the Japanese Orthopaedic Association score was significantly increased in the minimal y invasive transforaminal lumbar interbody fusion group at 3 days after internal fixation compared with open posterior transforaminal lumbar interbody fusion group (P<0.01), but there were no significant differences in the visual analogue scale score and Japanese Orthopaedic Association score between the two groups before operation and 6 months after operation (P>0.05).The results indicate that minimal y invasive transforaminal lumbar interbody fusion with real-time three-dimensional navigation system is an effective method for lumbar disc herniation with the advantages of less intraoperative blood loss, less postoperative drainage volume, smal trauma, short hospital stay and short-term efficacy.
