CAJ | 학술논문

背景：传统开放经椎间孔腰椎体间融合对椎旁软组织剥离范围较广，组织牵拉时间较长，创伤大，失血量多。微创经椎间孔腰椎体间融合可以减少或避免上述缺点，但也存在曲折的学习曲线过程，因此正确了解其并发症并及时预防具有积极的临床意义。目的：总结微创经椎间孔腰椎体间融合修复腰椎疾病的并发症，并探讨其防治策略。方法：于2008年5月至2012年5月采用微创经椎间孔腰椎体间融合修复腰椎疾病患者100例，所有患者均存在明显腰腿痛并经保守治疗6个月无效。其中腰椎管狭窄症42例，腰椎滑脱症31例，腰椎间盘突出伴侧隐窝狭窄症27例；L3/42例，L4/528例，L5/S150例，L3-L52例、L4-S1结果与结论：1例患者在处理椎间隙时，出现硬膜外出血量约为1000 mL，给予输血，未出现并发症。共11枚螺钉置入后发现位置不良，占总螺钉数的2.5%(11/435)，其中1例(1枚)螺钉的1/3直径在椎管内，并引起L 18例。记录其相关并发症及处理方法。5神经根性疼痛，再次手术后症状消失。2例置入后发现cage位置不良，占总cage的1.7%(2/120)，2例患者均无临床症状，未处理。1例患者随访中发现cage移位，占总cage的0.8%(1/120)，翻修2次痊愈，第1次采用重置cage，后出现再次移位；第2次采用后路腰椎间融合治愈。治疗后1个月内，2例患者肺动脉造影显示右肺动脉显影不良，诊断为肺栓塞，经碎栓及溶栓治疗，未出现死亡等不良后果。提示微创经椎间孔腰椎体间融合修复腰椎疾病为安全可靠并发症较低的方法之一。
배경：전통개방경추간공요추체간융합대추방연조직박리범위교엄，조직견랍시간교장，창상대，실혈량다。미창경추간공요추체간융합가이감소혹피면상술결점，단야존재곡절적학습곡선과정，인차정학료해기병발증병급시예방구유적겁적림상의의。목적：총결미창경추간공요추체간융합수복요추질병적병발증，병탐토기방치책략。방법：우2008년5월지2012년5월채용미창경추간공요추체간융합수복요추질병환자100례，소유환자균존재명현요퇴통병경보수치료6개월무효。기중요추관협착증42례，요추활탈증31례，요추간반돌출반측은와협착증27례；L3/42례，L4/528례，L5/S150례，L3-L52례、L4-S1결과여결론：1례환자재처리추간극시，출현경막외출혈량약위1000 mL，급여수혈，미출현병발증。공11매라정치입후발현위치불량，점총라정수적2.5%(11/435)，기중1례(1매)라정적1/3직경재추관내，병인기L 18례。기록기상관병발증급처리방법。5신경근성동통，재차수술후증상소실。2례치입후발현cage위치불량，점총cage적1.7%(2/120)，2례환자균무림상증상，미처리。1례환자수방중발현cage이위，점총cage적0.8%(1/120)，번수2차전유，제1차채용중치cage，후출현재차이위；제2차채용후로요추간융합치유。치료후1개월내，2례환자폐동맥조영현시우폐동맥현영불량，진단위폐전새，경쇄전급용전치료，미출현사망등불량후과。제시미창경추간공요추체간융합수복요추질병위안전가고병발증교저적방법지일。
BACKGROUND:Traditional open surgical transforaminal lumbar interbody fusion often needs a broader dissection of the paraspinal soft tissue and longer stretch time of soft tissue, induces greater surgical trauma and more blood loss. Minimal y invasive transforaminal lumbar interbody fusion (MIS-TLIF) may reduce or avoid these shortcomings. However, MIS-TLIF technique needs a process of learning curve. Correctly understanding the MIS-TLIF technique and dealing with their associated complications, have an important clinical significance. OBJECTIVE:To summarize the MIS-TLIF complications for treatment of lumbar disease, and explore the prevention and treatment strategies. METHODS:Between May 2008 and May 2012, 100 patients with lumbar disease were treated using MIS-TLIF. Al of patients had typical low back pain combined with leg pain, and were ineffective by conservative treatment for 6 months. There were lumbar spinal stenosis syndrome in 42 cases, lumbar spondylolisthesis in 31 cases, and lumbar disc herniation with lateral recess stenosis in 27 cases. The operative levels included L 3/4 in 2 patients, L 4/5 in 28 patients, L 5/S 1 in 50 patients, L 3-L 5 in 2 patients, and L 4-S 1 in 18 patients. The intraoperative and postoperative complications were recorded. RESULTS AND CONCLUSION:One patient appeared extradural hemorrhage 1 000 mL and was given blood transfusion, no complications were found. Pedicle screw malposition was found in 11 pedicle screws (11/435, 2.5%). Only one patient had new L 5 radicular pain due to impingement by the tip of a bicortical S 1 screw upon the lumbosacral trunk anterior to the sacrum. This screw was re-positioned at a subsequent procedure, with resolution of the radicular pain. Interbody cage malposition was found in 2 patients with 2 cages (2/120, 1.7%) after operations, they showed no clinical symptoms and were not treated. One patient with one cage (1/120, 0.8%) appeared cage displacement during fol ow-up, which required twice revision surgeries, one is cage re-position and the other is posterior interbody fusion. Within one month after operations, two patients had poor visualization in the right pulmonary arteriography, which was diagnosed as pulmonary embolism and was treated with thrombectomy and thrombolysis. No death and other consequence were found. Experimental findings indicate hat, MIS-TLIF is a safe, reliable and effective surgery for treating lumbar diseases, with few complications.