中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2015年
6期
507-511
,共5页
刘新宇%原所茂%田永昊%郑燕平%王连雷%李建民
劉新宇%原所茂%田永昊%鄭燕平%王連雷%李建民
류신우%원소무%전영호%정연평%왕련뢰%리건민
腰椎%神经变性疾病%外科手术,微创性
腰椎%神經變性疾病%外科手術,微創性
요추%신경변성질병%외과수술,미창성
Lumbar vertebrae%Neurodegenerative diseases%Surgical procedures,minimally invasive
目的 比较微创经椎间孔椎间融合内固定(M-TLIF)和Wiltse入路经椎间孔椎间融合内固定(W-TLIF)治疗单节段腰椎退行性疾病的临床疗效. 方法 回顾分析2009年12月-2010年12月收治的单节段腰椎退行性病变患者57例,根据手术方式分为M-TLIF组(27例)和W-TLIF组(30例).M-TLIF组损伤部位:L4～5 11例,L5～S116例.腰椎峡部裂性滑脱19例(Ⅰ度滑脱17例,Ⅱ度2例),腰椎管狭窄症合并不稳4例,腰椎间盘突出症合并椎管后方巨大骨赘2例,腰椎间盘突出症椎板开窗术后复发1例,腰椎管狭窄症减压术后复发1例.W-TLIF组损伤部位:L4～512例,L5～S118例.腰椎峡部裂性滑脱19例(Ⅰ度滑脱18例,Ⅱ度1例),腰椎间盘突出症术后翻修3例,腰椎管狭窄症8例.采用日本骨科协会(JOA)评分、视觉模拟评分(VAS)评估两组腰痛和下肢痛,改良Brantigan评分评价两组椎间融合情况. 结果 两组手术时间差异无统计学意义.M-TLIF组与W-TLIF组比较,手术切口短、出血量少[(5.1±0.7)cm∶ (6.9±1.0)cm]、[(90.1 ±10.5)ml∶(155.3±21.2)ml](P＜0.05). M-TLIF组术后1,3d切口处痛VAS分别为(2.1 ±0.5)分、(1.0±0.1)分,W-TLIF组分别为(3.6±0.1)分、(2.4±1.0)分(P＜0.05).术中X线透视次数M-TLIF组为(46±9)次、W-TLIF组为(7±2)次(P＜0.05).两组均获得随访24 ～36个月,平均26.7个月.末次随访时两组JOA评分、JOA改善率、下肢痛VAS差异均无统计学意义;M-TLIF组、W-TLIF组腰痛VAS分别为(1.0±0.2)分、(1.9±0.3)分(P＜0.05);M-TLIF组改良Brantigan评分≥3分24例(89％),W-TLIF组27例(90％),两组椎间融合率差异无统计学意义. 结论 对于腰椎退行性疾病,两种经椎间孔椎间融合术均能获得良好的疗效.与W-TLIF比较,M-TLIF具有术中出血量少、手术切口短、术后腰痛改善明显的优点,但X线透视次数多.
目的 比較微創經椎間孔椎間融閤內固定(M-TLIF)和Wiltse入路經椎間孔椎間融閤內固定(W-TLIF)治療單節段腰椎退行性疾病的臨床療效. 方法 迴顧分析2009年12月-2010年12月收治的單節段腰椎退行性病變患者57例,根據手術方式分為M-TLIF組(27例)和W-TLIF組(30例).M-TLIF組損傷部位:L4～5 11例,L5～S116例.腰椎峽部裂性滑脫19例(Ⅰ度滑脫17例,Ⅱ度2例),腰椎管狹窄癥閤併不穩4例,腰椎間盤突齣癥閤併椎管後方巨大骨贅2例,腰椎間盤突齣癥椎闆開窗術後複髮1例,腰椎管狹窄癥減壓術後複髮1例.W-TLIF組損傷部位:L4～512例,L5～S118例.腰椎峽部裂性滑脫19例(Ⅰ度滑脫18例,Ⅱ度1例),腰椎間盤突齣癥術後翻脩3例,腰椎管狹窄癥8例.採用日本骨科協會(JOA)評分、視覺模擬評分(VAS)評估兩組腰痛和下肢痛,改良Brantigan評分評價兩組椎間融閤情況. 結果 兩組手術時間差異無統計學意義.M-TLIF組與W-TLIF組比較,手術切口短、齣血量少[(5.1±0.7)cm∶ (6.9±1.0)cm]、[(90.1 ±10.5)ml∶(155.3±21.2)ml](P＜0.05). M-TLIF組術後1,3d切口處痛VAS分彆為(2.1 ±0.5)分、(1.0±0.1)分,W-TLIF組分彆為(3.6±0.1)分、(2.4±1.0)分(P＜0.05).術中X線透視次數M-TLIF組為(46±9)次、W-TLIF組為(7±2)次(P＜0.05).兩組均穫得隨訪24 ～36箇月,平均26.7箇月.末次隨訪時兩組JOA評分、JOA改善率、下肢痛VAS差異均無統計學意義;M-TLIF組、W-TLIF組腰痛VAS分彆為(1.0±0.2)分、(1.9±0.3)分(P＜0.05);M-TLIF組改良Brantigan評分≥3分24例(89％),W-TLIF組27例(90％),兩組椎間融閤率差異無統計學意義. 結論 對于腰椎退行性疾病,兩種經椎間孔椎間融閤術均能穫得良好的療效.與W-TLIF比較,M-TLIF具有術中齣血量少、手術切口短、術後腰痛改善明顯的優點,但X線透視次數多.
목적 비교미창경추간공추간융합내고정(M-TLIF)화Wiltse입로경추간공추간융합내고정(W-TLIF)치료단절단요추퇴행성질병적림상료효. 방법 회고분석2009년12월-2010년12월수치적단절단요추퇴행성병변환자57례,근거수술방식분위M-TLIF조(27례)화W-TLIF조(30례).M-TLIF조손상부위:L4～5 11례,L5～S116례.요추협부렬성활탈19례(Ⅰ도활탈17례,Ⅱ도2례),요추관협착증합병불은4례,요추간반돌출증합병추관후방거대골췌2례,요추간반돌출증추판개창술후복발1례,요추관협착증감압술후복발1례.W-TLIF조손상부위:L4～512례,L5～S118례.요추협부렬성활탈19례(Ⅰ도활탈18례,Ⅱ도1례),요추간반돌출증술후번수3례,요추관협착증8례.채용일본골과협회(JOA)평분、시각모의평분(VAS)평고량조요통화하지통,개량Brantigan평분평개량조추간융합정황. 결과 량조수술시간차이무통계학의의.M-TLIF조여W-TLIF조비교,수술절구단、출혈량소[(5.1±0.7)cm∶ (6.9±1.0)cm]、[(90.1 ±10.5)ml∶(155.3±21.2)ml](P＜0.05). M-TLIF조술후1,3d절구처통VAS분별위(2.1 ±0.5)분、(1.0±0.1)분,W-TLIF조분별위(3.6±0.1)분、(2.4±1.0)분(P＜0.05).술중X선투시차수M-TLIF조위(46±9)차、W-TLIF조위(7±2)차(P＜0.05).량조균획득수방24 ～36개월,평균26.7개월.말차수방시량조JOA평분、JOA개선솔、하지통VAS차이균무통계학의의;M-TLIF조、W-TLIF조요통VAS분별위(1.0±0.2)분、(1.9±0.3)분(P＜0.05);M-TLIF조개량Brantigan평분≥3분24례(89％),W-TLIF조27례(90％),량조추간융합솔차이무통계학의의. 결론 대우요추퇴행성질병,량충경추간공추간융합술균능획득량호적료효.여W-TLIF비교,M-TLIF구유술중출혈량소、수술절구단、술후요통개선명현적우점,단X선투시차수다.
Objective To compare the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (M-TLIF) and Wiltse-approach TLIF (W-TLIF) in treating single-level degenerative lumbar disease.Methods A retrospective review was performed on the 57 patients with single-level degenerative lumbar disorder managed via M-TLIF (n =27) and W-TLIF (n =30) from December 2009 to December 2010.In M-TLIF group degeneration at the L4-5 disc were noted in 11 cases and at the L5-S1 disc in 16 cases.And 19 cases were diagnosed with lumbar isthmus spondylolisthesis (17 with Grade Ⅰ spondylolisthesis and 2 with Grade Ⅱ spondylolisthesis),4 lumbar spinal stenosis and instability,2 lumbar disc herniation combined with huge posterior osteophytes,1 recurrent lumbar disc herniation after lumbar fenestration,and 1 recurrent lumbar spinal stenosis after decompression.In W-TLIF group degeneration at L4～5 disc were noted in 12 cases and at the L5-S1 disc in 18 cases.There were 19 cases diagnosed with lumbar isthmus spondylolisthesis (18 with Grade Ⅰ spondylolisthesis and 1 with Grade Ⅱ spondylolisthesis),3 with lumbar disc herniation,and 8 with lumbar spinal stenosis.Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) were used to measure low back and leg pain.Modified Brantigan score was used to assess lumbar interbody fusion.Results Operative time was not significantly different between the two groups (P ＞ 0.05).Incision length and mean blood loss were (5.1 ± 0.7) cm and (90.1 ± 10.5) ml in M-TLIF group,but were (6.9 ± 1.0)cm and (155.3 ±21.2)ml in W-TLIF group (P＜0.05).At postoperative 1 and 3 days VAS in M-TLIF group was (2.1 ± 0.5) points and (1.0 ± 0.1) points respectively,but in W-TLIF group was (3.6 ± 0.1) points and (2.4 ± 1.0) points respectively (P ＜ 0.05).Intraoperative X-ray fluoroscopy frequencies were (46 ± 9) times in M-TLIF group and (7 ± 2) times in W-TLIF group (P ＜ 0.05).Mean period of follow-up was 26.7 months (range,24-36 months).At final follow-up,JOA score,VAS for leg pain and lumbar interbody fusion rate revealed no significant differences between the two groups (P ＞ 0.05),but VAS for lumbar pain was (1.0 ± 0.2) points in M-TLIF group versus (1.9 ± 0.3) points in W-TLIF group (P ＜0.05).Twenty-four cases (89％) had Brantigan score of 3 or over in M-TLIF group and 27 cases (90％) in W-TLIF group,indicating a similar interbody fusion rate (P ＞ 0.05).Conclusions Both lumbar fusion methods are effective in treatment of lumbar degenerative disease.M-TLIF lumbar fusion results in small amount of bleeding,small incision and significantly improved lower back pain as compared with W-TLIF,but W-TLIF involves less exposure to the X-rays.
