中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
35期
23-26
,共4页
李光富%刘文斌%周焱涛%丁平
李光富%劉文斌%週焱濤%丁平
리광부%류문빈%주염도%정평
椎管狭窄%椎旁肌间隙入路%经椎间孔腰椎体间融合术
椎管狹窄%椎徬肌間隙入路%經椎間孔腰椎體間融閤術
추관협착%추방기간극입로%경추간공요추체간융합술
Spinal stenosis%Wiltse approach%Transforaminal lumbar interbody fusion
目的 比较椎旁肌间隙入路(Wiltse入路)与后正中入路经椎间孔腰椎体间融合术治疗腰椎管狭窄症的疗效.方法 回顾性分析96例腰椎管狭窄症患者的临床资料,其中42例采用Wiltse入路(Wiltse组)、54例采用传统后正中入路(对照组),比较两组在手术时间、显露时间、显露出血量、切口长度、术中总出血量、术后第3天切口疼痛视觉模拟评分(VAS)以及术后1年腰腿部VAS、下腰部日本骨科协会(JOA)评分和罗兰-莫里斯腰部疼痛功能障碍问卷(RDQ)评分方面的差异.结果 Wiltse组切口长度为(5.0±1.2) cm,显露时间为(20.0±7.6) min,手术时间为(150.0±8.4) min,显露出血量和术中总出血量分别为(10.6±5.4) ml和(125.5±10.6) ml,术后第3天切口VAS为(4.5±0.6)分,术后1年腰部VAS为(1.0±0.5)分,均明显优于对照组的(8.0±1.6) cm、(35.2±6.8) min、(162.0±5.6) min、(84.5±7.8) ml、(186.4±15.4) ml、(6.8±0.5)分、(2.5±0.8)分,差异均有统计学意义(P＜0.01).但两组术后1年腿部VAS、下腰部JOA评分和RDQ评分比较差异无统计学意义(P＞0.05).结论 两种入路经椎间孔腰椎体间融合术治疗腰椎管狭窄症均能达到良好的治疗效果,但Wiltse入路手术切口小,术中剥离少,出血少,术后腰部疼痛的发生率更低.
目的 比較椎徬肌間隙入路(Wiltse入路)與後正中入路經椎間孔腰椎體間融閤術治療腰椎管狹窄癥的療效.方法 迴顧性分析96例腰椎管狹窄癥患者的臨床資料,其中42例採用Wiltse入路(Wiltse組)、54例採用傳統後正中入路(對照組),比較兩組在手術時間、顯露時間、顯露齣血量、切口長度、術中總齣血量、術後第3天切口疼痛視覺模擬評分(VAS)以及術後1年腰腿部VAS、下腰部日本骨科協會(JOA)評分和囉蘭-莫裏斯腰部疼痛功能障礙問捲(RDQ)評分方麵的差異.結果 Wiltse組切口長度為(5.0±1.2) cm,顯露時間為(20.0±7.6) min,手術時間為(150.0±8.4) min,顯露齣血量和術中總齣血量分彆為(10.6±5.4) ml和(125.5±10.6) ml,術後第3天切口VAS為(4.5±0.6)分,術後1年腰部VAS為(1.0±0.5)分,均明顯優于對照組的(8.0±1.6) cm、(35.2±6.8) min、(162.0±5.6) min、(84.5±7.8) ml、(186.4±15.4) ml、(6.8±0.5)分、(2.5±0.8)分,差異均有統計學意義(P＜0.01).但兩組術後1年腿部VAS、下腰部JOA評分和RDQ評分比較差異無統計學意義(P＞0.05).結論 兩種入路經椎間孔腰椎體間融閤術治療腰椎管狹窄癥均能達到良好的治療效果,但Wiltse入路手術切口小,術中剝離少,齣血少,術後腰部疼痛的髮生率更低.
목적 비교추방기간극입로(Wiltse입로)여후정중입로경추간공요추체간융합술치료요추관협착증적료효.방법 회고성분석96례요추관협착증환자적림상자료,기중42례채용Wiltse입로(Wiltse조)、54례채용전통후정중입로(대조조),비교량조재수술시간、현로시간、현로출혈량、절구장도、술중총출혈량、술후제3천절구동통시각모의평분(VAS)이급술후1년요퇴부VAS、하요부일본골과협회(JOA)평분화라란-막리사요부동통공능장애문권(RDQ)평분방면적차이.결과 Wiltse조절구장도위(5.0±1.2) cm,현로시간위(20.0±7.6) min,수술시간위(150.0±8.4) min,현로출혈량화술중총출혈량분별위(10.6±5.4) ml화(125.5±10.6) ml,술후제3천절구VAS위(4.5±0.6)분,술후1년요부VAS위(1.0±0.5)분,균명현우우대조조적(8.0±1.6) cm、(35.2±6.8) min、(162.0±5.6) min、(84.5±7.8) ml、(186.4±15.4) ml、(6.8±0.5)분、(2.5±0.8)분,차이균유통계학의의(P＜0.01).단량조술후1년퇴부VAS、하요부JOA평분화RDQ평분비교차이무통계학의의(P＞0.05).결론 량충입로경추간공요추체간융합술치료요추관협착증균능체도량호적치료효과,단Wiltse입로수술절구소,술중박리소,출혈소,술후요부동통적발생솔경저.
Objective To compare the curative effect of transforaminal lumbar interbody fusion by Wihse approach and posterior median approach in treatment of lumbar spinal canal stenosis.Methods Ninety-six patients with lumbar spinal canal stenosis were treated with transforaminal lumbar interbody fusion by Wihse approach (42 cases,Wihse group) and posterior median approach (54 cases,control group).The operation time,exposure time,exposure bleeding volume,length of incision,intraoperative bleeding volume,visual analog score (VAS) of nick at the third day after surgery,and VAS of lumbar and leg,Japanese orthopedic association (JOA) score and Roland-Morris disability questionnaire (RDQ) score at 1 year after surgery were compared between the 2 groups.Results The length of incision,exposure time,operation time,exposure bleeding volume,intraoperative bleeding volume,VAS of nick at the third day after surgery and VAS of lumbar at 1 year after surgery in Wiltse group were (5.0 ± 1.2) cm,(20.0 ± 7.6) min,(150.0 ± 8.4) min,(10.6 ±5.4) ml,(125.5 ± 10.6) ml,(4.5 ±0.6) scores and (1.0 ±0.5) scores,and in control group were (8.0 ± 1.6) cm,(35.2 ±6.8) min,(162.0 ±5.6) min,(84.5 ±7.8) ml,(186.4 ± 15.4) ml,(6.8 ± 0.5) scores and (2.5 ± 0.8) scores],there were statistical differences between the 2 groups (P ＜ 0.01).But there were no statistical differences in the VAS of leg,JOA score and RDQ score at 1 year after surgery between the 2 groups (P ＞ 0.05).Conclusion Two kinds of approach transforaminal lumbar interbody fusions all have good therapeutic effect on lumbar spinal canal stenosis,but the Wiltse approach has advantages of small incision,less intraoperative dissection,less bleeding and low incidence of postoperative lumbodynia.
