中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2014年
7期
749-755
,共7页
沈晓龙%张海龙%顾昕%贺石生
瀋曉龍%張海龍%顧昕%賀石生
침효룡%장해룡%고흔%하석생
腰椎%外科手术,微创性%脊柱融合术
腰椎%外科手術,微創性%脊柱融閤術
요추%외과수술,미창성%척주융합술
Lumbar Vertebrae%Surgical procedures,minimally invasive%Spinal fusion
目的 探讨微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)联合单侧或双侧内固定治疗单节段腰椎退行性疾病的临床及影像学疗效.方法 回顾性分析2009年10月至2011年12月期间,采用METRx-MD(Microscopic Endoscopic Tubular Retractor System)进行MIS-TLIF治疗单节段腰椎退行性疾病并获得长期随访的65例患者的相关资料.根据内固定方式分为两组,单侧固定组(31例)采用MIS-TLIF联合单侧内固定技术,双侧组(34例)采用MIS-TLIF联合双侧经皮内固定技术.采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价腰椎功能情况,采用疼痛视觉模拟评分(visual analogue scale,VAS)分别对腰痛及下肢痛进行评估;在X线片上测量手术前后的腰椎前凸角度、手术节段前凸角度、腰椎侧凸角度、手术节段侧凸角度,计算腰椎前凸指数及椎间高度指数.结果 所有患者均顺利完成手术,术后随访18～36个月,平均26.6个月.所有患者术后12个月均获得骨性融合.两组患者术后VAS及ODI评分均较术前有明显改善,两组间术前及随访期间VAS及ODI评分的差异无统计学意义.影像学测量结果显示两组间腰椎前凸角度、手术节段前凸角度、腰椎侧凸角度、手术节段侧凸角度、腰椎前凸指数及椎间高度指数的差异均无统计学意义,腰椎前凸角度与腰椎前凸指数呈线性相关.结论 对于治疗单间隙腰椎退变性疾病,MIS-TLIF联合单侧或双侧经皮内固定技术具有相似的临床及影像学疗效.
目的 探討微創經椎間孔椎間融閤術(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)聯閤單側或雙側內固定治療單節段腰椎退行性疾病的臨床及影像學療效.方法 迴顧性分析2009年10月至2011年12月期間,採用METRx-MD(Microscopic Endoscopic Tubular Retractor System)進行MIS-TLIF治療單節段腰椎退行性疾病併穫得長期隨訪的65例患者的相關資料.根據內固定方式分為兩組,單側固定組(31例)採用MIS-TLIF聯閤單側內固定技術,雙側組(34例)採用MIS-TLIF聯閤雙側經皮內固定技術.採用Oswestry功能障礙指數(Oswestry disability index,ODI)評價腰椎功能情況,採用疼痛視覺模擬評分(visual analogue scale,VAS)分彆對腰痛及下肢痛進行評估;在X線片上測量手術前後的腰椎前凸角度、手術節段前凸角度、腰椎側凸角度、手術節段側凸角度,計算腰椎前凸指數及椎間高度指數.結果 所有患者均順利完成手術,術後隨訪18～36箇月,平均26.6箇月.所有患者術後12箇月均穫得骨性融閤.兩組患者術後VAS及ODI評分均較術前有明顯改善,兩組間術前及隨訪期間VAS及ODI評分的差異無統計學意義.影像學測量結果顯示兩組間腰椎前凸角度、手術節段前凸角度、腰椎側凸角度、手術節段側凸角度、腰椎前凸指數及椎間高度指數的差異均無統計學意義,腰椎前凸角度與腰椎前凸指數呈線性相關.結論 對于治療單間隙腰椎退變性疾病,MIS-TLIF聯閤單側或雙側經皮內固定技術具有相似的臨床及影像學療效.
목적 탐토미창경추간공추간융합술(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)연합단측혹쌍측내고정치료단절단요추퇴행성질병적림상급영상학료효.방법 회고성분석2009년10월지2011년12월기간,채용METRx-MD(Microscopic Endoscopic Tubular Retractor System)진행MIS-TLIF치료단절단요추퇴행성질병병획득장기수방적65례환자적상관자료.근거내고정방식분위량조,단측고정조(31례)채용MIS-TLIF연합단측내고정기술,쌍측조(34례)채용MIS-TLIF연합쌍측경피내고정기술.채용Oswestry공능장애지수(Oswestry disability index,ODI)평개요추공능정황,채용동통시각모의평분(visual analogue scale,VAS)분별대요통급하지통진행평고;재X선편상측량수술전후적요추전철각도、수술절단전철각도、요추측철각도、수술절단측철각도,계산요추전철지수급추간고도지수.결과 소유환자균순리완성수술,술후수방18～36개월,평균26.6개월.소유환자술후12개월균획득골성융합.량조환자술후VAS급ODI평분균교술전유명현개선,량조간술전급수방기간VAS급ODI평분적차이무통계학의의.영상학측량결과현시량조간요추전철각도、수술절단전철각도、요추측철각도、수술절단측철각도、요추전철지수급추간고도지수적차이균무통계학의의,요추전철각도여요추전철지수정선성상관.결론 대우치료단간극요추퇴변성질병,MIS-TLIF연합단측혹쌍측경피내고정기술구유상사적림상급영상학료효.
Objective To explore the clinical and radiographic outcomes of minimally invasive transforarninal lumbar interbody fusion (MIS-TLIF) with unilateral pedicle screw fixation in treatment of one-level lumbar degenerative disease.Methods A total of 65 patients suffered from one-level lumbar degenerative disease between October 2009 and December 2011.They were divided into 2 groups according to different fixation ways.31 patients were given MIS-TLIF with unilateral pedicle screw fixation.The other 34 patients were given MIS-TLIF with bilateral pedicle screw fixation.Microscopic tubular retractor system (METRxMD) and Sextant system were used in all the procedures of treatment.The whole lumbar lordosis (WL),the segmnental lordosis (SL),fusion level disc space angle,lumbar scoliosis angle,and segmental scoliosis angle were measured pre and post operation according to standarded X-rays.The disc height index (DI) and the lumber curvature index (LI) were also evaluated.The Oswestry disability index (ODI) score and visual analog scale (VAS) pain score data were obtained from all the patients pre-operation and during each following-up procedure.Results All the patients were well followed up 18 months to 36 months(average 26.6 months).All the 65 patients were proved to achieve bone fusion in 12 months post-operation.The ODI and VAS scores post-operation improved significantly in each group,but showed no significant difference between the 2 groups.Likewise,there were no significant differences between the 2 groups in datas of WL,SL,fusion level disc space angle,lumbar scoliosis angle,segmental scoliosis angle,DI,and LI.But there was a positive linear correlation between the LI and WL in the 2 groups.Conclusion MIS-TLIF with unilateral pedicle screw fixation is as good as MIS-TLIF with bilateral pedicle screw fixation in patients of one-level lumbar degenerative disease.
