中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2013年
8期
723-727
,共5页
毛克亚%王岩%肖嵩华%张永刚%刘保卫%王征%张西峰%崔庚%张雪松
毛剋亞%王巖%肖嵩華%張永剛%劉保衛%王徵%張西峰%崔庚%張雪鬆
모극아%왕암%초숭화%장영강%류보위%왕정%장서봉%최경%장설송
腰椎%椎间盘移位%复发%外科手术,微创性%骨钉%内固定器
腰椎%椎間盤移位%複髮%外科手術,微創性%骨釘%內固定器
요추%추간반이위%복발%외과수술,미창성%골정%내고정기
Lumbar vertebrae%Intervertebral disk displacement%Recurrence%Surgical procedures,minimally invasive%Bone pins%Internal fixtors
目的 探讨微创腰椎经椎间孔椎体间融合术(MIS-TLIF)采用椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定治疗复发性腰椎间盘突出症的可行性.方法 选取2010年1月至2011年12月符合纳入排除标准的16例复发性腰椎间盘突出症患者资料进行回顾性研究.其中男性10例,女性6例,年龄35 ~ 68岁,平均45岁.采用单侧切口工作通道下完成MIS-TLIF手术,在完成椎管减压、椎体间融合和单侧椎弓根螺钉内固定后,同一切口经棘突根部向对侧置入经椎板关节突螺钉,进行围手术期指标观察、影像学和疗效评价.视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分的比较采用重复测量方差分析.结果 所有患者均在工作通道下顺利完成椎管内减压、椎体间融合和混合内固定,无患者出现神经症状.平均手术时间(148±75) min,术中出血量(186±226) ml,术后平均下床活动时间(32±15)h,平均住院日(6±4)d,手术切口长度平均(29±4) mm,经椎板关节突螺钉平均长度(52 ±6) mm.患者术后随访12 ~ 24个月,平均16.5个月.术后X线和CT显示混合内固定位置良好,经棘突椎板关节突螺钉均穿过椎板和关节突关节,术后随访期间腰痛和腿痛VAS与ODI评分与术前相比较均明显改善,差异有统计学意义(腰痛VAS:F=52.845,P=0.000;腿痛VAS:F=113.480,P=0.000; ODI评分:F=36.665,P=0.000).结论 单侧切口MIS-TLIF采用混合内固定可治疗复发性腰椎间盘突出症,具有创伤小、恢复快等优点.
目的 探討微創腰椎經椎間孔椎體間融閤術(MIS-TLIF)採用椎弓根螺釘結閤對側經椎闆關節突螺釘混閤內固定治療複髮性腰椎間盤突齣癥的可行性.方法 選取2010年1月至2011年12月符閤納入排除標準的16例複髮性腰椎間盤突齣癥患者資料進行迴顧性研究.其中男性10例,女性6例,年齡35 ~ 68歲,平均45歲.採用單側切口工作通道下完成MIS-TLIF手術,在完成椎管減壓、椎體間融閤和單側椎弓根螺釘內固定後,同一切口經棘突根部嚮對側置入經椎闆關節突螺釘,進行圍手術期指標觀察、影像學和療效評價.視覺模擬量錶(VAS)評分和Oswestry功能障礙指數(ODI)評分的比較採用重複測量方差分析.結果 所有患者均在工作通道下順利完成椎管內減壓、椎體間融閤和混閤內固定,無患者齣現神經癥狀.平均手術時間(148±75) min,術中齣血量(186±226) ml,術後平均下床活動時間(32±15)h,平均住院日(6±4)d,手術切口長度平均(29±4) mm,經椎闆關節突螺釘平均長度(52 ±6) mm.患者術後隨訪12 ~ 24箇月,平均16.5箇月.術後X線和CT顯示混閤內固定位置良好,經棘突椎闆關節突螺釘均穿過椎闆和關節突關節,術後隨訪期間腰痛和腿痛VAS與ODI評分與術前相比較均明顯改善,差異有統計學意義(腰痛VAS:F=52.845,P=0.000;腿痛VAS:F=113.480,P=0.000; ODI評分:F=36.665,P=0.000).結論 單側切口MIS-TLIF採用混閤內固定可治療複髮性腰椎間盤突齣癥,具有創傷小、恢複快等優點.
목적 탐토미창요추경추간공추체간융합술(MIS-TLIF)채용추궁근라정결합대측경추판관절돌라정혼합내고정치료복발성요추간반돌출증적가행성.방법 선취2010년1월지2011년12월부합납입배제표준적16례복발성요추간반돌출증환자자료진행회고성연구.기중남성10례,녀성6례,년령35 ~ 68세,평균45세.채용단측절구공작통도하완성MIS-TLIF수술,재완성추관감압、추체간융합화단측추궁근라정내고정후,동일절구경극돌근부향대측치입경추판관절돌라정,진행위수술기지표관찰、영상학화료효평개.시각모의량표(VAS)평분화Oswestry공능장애지수(ODI)평분적비교채용중복측량방차분석.결과 소유환자균재공작통도하순리완성추관내감압、추체간융합화혼합내고정,무환자출현신경증상.평균수술시간(148±75) min,술중출혈량(186±226) ml,술후평균하상활동시간(32±15)h,평균주원일(6±4)d,수술절구장도평균(29±4) mm,경추판관절돌라정평균장도(52 ±6) mm.환자술후수방12 ~ 24개월,평균16.5개월.술후X선화CT현시혼합내고정위치량호,경극돌추판관절돌라정균천과추판화관절돌관절,술후수방기간요통화퇴통VAS여ODI평분여술전상비교균명현개선,차이유통계학의의(요통VAS:F=52.845,P=0.000;퇴통VAS:F=113.480,P=0.000; ODI평분:F=36.665,P=0.000).결론 단측절구MIS-TLIF채용혼합내고정가치료복발성요추간반돌출증,구유창상소、회복쾌등우점.
Objective To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation.Methods From January 2010 to December 2011,16 recurrent lumbar disc herniation patients,10 male and 6 female patients with an average age of 45 years(35-68 years) were treated with unilateral incision MIS-TLIF through working channel.After decompression,interbody fusion and fixation using unilateral pedicle screws,a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint.The results of perioperative parameters,radiographic images and clinical outcomes were assessed.The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI).Results All patients MIS-TLIF were accomplished under working channel including decompression,interbody fusion and hybrid fixation without any neural complication.The average operative time was (148 ± 75) minutes,the average operative blood loss was (186 ±226) ml,the average postoperative ambulation time was (32 ± 15) hours,and the average hospitalization time was (6 ± 4) days.The average length of incision was (29 ± 4) mm,and the average length of translaminar facets screw was (52 ± 6) mm.The mean follow-up was 16.5 months with a range of 12-24 months.The postoperative X-ray and CT images showed good position of the hybrid internal fixation,and all facets screws penetrate through facets joint.The significant improvement could be found in back pain VAS,leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845,P = 0.000 ; leg pain VAS:F = 113.480,P =0.000;ODI:F =36.665,P =0.000).Conclusion Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision,and the advantage including less invasion and quickly recovery.