显微镜辅助下MIS-TLIF治疗腰椎单节段退行性疾病的临床疗效观察

doi:10.13418/j.issn.1001-165x.2020.04.017

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (4): 455-460.doi: 10.13418/j.issn.1001-165x.2020.04.017

显微镜辅助下MIS-TLIF治疗腰椎单节段退行性疾病的临床疗效观察

陈鹏程¹，钟海琳²，　王乐²，　张海英³，　刘亦恒^{1, 2}，　连小峰²

1.中南大学湘雅医学院附属海口医院骨科，海口 570208； 2.上海市第六人民医院海口骨科与糖尿病医院骨科，海口 570311； 3.海南医学院人体解剖学教研室，海口 571101

收稿日期:2019-05-17 出版日期:2020-07-25 发布日期:2020-07-29
通讯作者: 刘亦恒，E-mail：1398345154@qq.com
作者简介:陈鹏程（1992-），男，在读硕士，住院医师，E-mail：625820273@qq.com
基金资助:
国家自然基金项目（81660224；81100246）；海南省重点研发计划项目（ZDYF2017120）；海南省卫计委科教项目（18A200115）；中南大学湘雅医学院附属海口医院院内项目（2018-YNP-01-003）

Clinical efficacy of MIS-TLIF assisted with microscope in treatment of lumbar single-segment degenerative diseases

CHEN Peng-cheng¹, ZHONG Hai-lin², WANG Le², ZHANG Hai-ying³, LIU Yi-heng^1,2, LIAN Xiao-feng²

1.Department of Orthopedics, Xiangya School of Medicine Affiliated Haikou Hospital ,Haikou 570208, China; 2.Department of Orthopedics, Haikou Orthopedics and Diabetes Hospital of Shanghai Sixth People's Hospital, Haikou 570311, China; 3. Department of Anatomy, Hainan Medical University, Haikou 571101, China

Received:2019-05-17 Online:2020-07-25 Published:2020-07-29

摘要/Abstract

摘要： 目的　探讨显微镜辅助下微创经椎间孔椎体间融合术（minimal invasive posterior transforminal lumbar interbody fusion，MIS-TLIF）治疗腰椎单节段退行性疾病的安全性及有效性。方法　回顾分析显微镜辅助下MIS-TLIF术42例（微创组）及同期行后路腰椎椎间融合术50例（传统组）治疗腰椎单节段退行性疾病患者临床资料，比较两组围手术期指标及临床疗效。结果　手术切口长度、术中出血量、术后引流量、术后住院时间、术后1 d肌酸激酶水平、术后3月ODI评分及术后1 d、术后3月VAS评分比较，微创组均低于传统组（P<0.05）；手术时间、术中X线照射次数，微创组多于传统组（P<0.05）。微创组患者出现1例术后背根神经节激惹症状；传统组出现1例术中硬膜撕裂，1例术后切口浅表感染，并发症发生率无统计学差异（P>0.05）。术后6月及末次随访ODI、VAS评分两组对比无统计学差异（P>0.05）。末次随访时，植骨融合率无统计学差异（P>0.05）。结论　与PLIF手术比较，显微镜辅助下MIS-TLIF治疗腰椎单节段退行性病变具有创伤小、近期疗效满意等优点。

关键词: 腰椎退行性疾病, 　显微镜, 　微创, 　经椎间孔椎体间融合术

Abstract: Objective　To investigate the safety and efficacy of microscope-assisted minimal invasive posterior transforminal lumbar interbody fusion (MIS-TLIF) in the treatment of single segmental degenerative diseases of lumbar vertebrae.　Methods　Clinical data of 42 patients (minimally invasive group) treated with microscope-assisted MIS-TLIF and 50 patients (traditional group) treated with PLIF were retrospectively analyzed. At the same time perioperative parameters, imaging and clinical efficacy of the two groups were compared.　Results　All patients were followed up, and 1 case of dorsal root ganglion irritation was found in the minimally invasive group. One case of dural tear and one case of superficial wound infection occurred in the traditional group. There was no statistical difference in the incidence of complications between the two groups (P>0.05). The incision length, intraoperative blood loss, postoperative drainage volume, postoperative hospital stay, creatine kinase level of 1 day after surgery, ODI score of 3 months after surgery, VAS score of 1 day after surgery and 3 months after surgery in the minimally invasive group were all lower than that of the traditional group (P<0.05). The operation time and time of intraoperative X-ray irradiation in the minimally invasive group were longer than that of the traditional group (P<0.05). There was no statistical difference between the ODI scores and VAS scores of 6 months after the operation and the last follow-up (P>0.05). At the last follow-up, there was no statistical difference in the rate of bone graft fusion (P>0.05).　Conclusions　Compared with PLIF surgery, microscope-assisted MIS-TLIF has the advantages of less trauma and satisfactory short-term efficacy in the treatment of lumbar degenerative diseases.

Key words: Lumbar degenerative diseases;　Microscope;　Minimally invasive surgery, Transforaminal interbody fusion

中图分类号:

R681.5

陈鹏程, 钟海琳, 王乐, 张海英, 刘亦恒, 连小峰. 显微镜辅助下MIS-TLIF治疗腰椎单节段退行性疾病的临床疗效观察[J]. 中国临床解剖学杂志, 2020, 38(4): 455-460.

CHEN Peng-cheng, ZHONG Hai-lin, WANG Le, ZHANG Hai-ying, LIU Yi-heng, LIAN Xiao-feng. Clinical efficacy of MIS-TLIF assisted with microscope in treatment of lumbar single-segment degenerative diseases[J]. Chinese Journal of Clinical Anatomy, 2020, 38(4): 455-460.

参考文献 17

[1]	李明, 种衍学, 宋将, 等. 腰椎椎体间融合不同手术入路及并发症究[J]. 中国矫形外科杂志, 2017, 25(13): 1210-1213.
[2]	Stevens KJ, Spenciner DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies[J]. J Spinal Disord Tech, 2006, 19(2): 77-86.
[3]	Kevin TF, Holly LT, Schwender JD, et al. Minimally invasive lumbar fusion[J]. Spine, 2003, 28(15 Suppl): S26-35.
[4]	Cloward RB, Posterior lumbar interbody fusion updated[J]. Clin Orthop Relat Res,1985, (193): 16-19.
[5]	Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbodyfusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis[J]. Spine (Phila Pa 1976), 1997, 22(2): 210-220.
[6]	Fogel GR, Toohey JS, Neidre A, et al. Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X-ray films and helical computed tomography scans compared with surgical exploration of fusion[J]. Spine J, 2008, 8 (4): 570-577.
[7]	Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the spine patient outcomes research trial[J]. Spine (Phila Pa 1976), 2010, 35(14):1329-1338.
[8]	Okuda S, Miyauchi A, Oda T, et al. Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients[J]. J Neurosurg Spine, 2006, 4(4): 304-309.
[9]	Vazan M, Gempt J, Meyer B, et al. Minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a technical description and review of the literature[J]. Acta Neurochir (Wien), 2017, 159(6): 1137-1146.
[10]	Masrouha KZ, Musallam KM, Rosendaal FR, et al. Preoperative pneumonia and postoperative venous thrombosis: a cohort study of 427,656 patients undergoing major general surgery[J]. World J Surg, 2016, 40(6): 1288-1294.
[11]	Burneikiene S, Nelson EL, Mason A, et al. Complications in patients undergoing combined transforaminal lumbar interbody fusion and posterior instrumentation with deformity correction for degenerative scoliosis and spinal stenosis[J]. Surg Neurol Int, 2012, 3: 25.
[12]	Yang Y, Zhang LM, Liu B, et al. Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion[J]. J Orthop Traumatol, 2017, 18(4): 395-400.
[13]	Meyer SA, Wu JC, Mummaneni PV. Mini-open and minimally invasive transforaminal lumbar interbody fusion: technique review[J]. Semin Spine Surg, 2011, 23(1): 45-50.
[14]	Wang MY, Cummock MD, Yu Y,et al. An analysis of the differences
	in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion[J]. J Neurosurg Spine 2010, 12(6): 694-699.
[15]	Singh K, Nandyala SV, Marquez-Lara A, et al. A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion[J]. Spine J, 2014, 14(8): 1694-1701.
[16]	Zhou Y, Zhang C, Wang J, et al. Endoscopic transforaminal lumbar decompression, interbody fusion and pedicle screw fixation-a report of 42 cases[J]. Chin J Traumatol, 2008, 11(4): 225-231.
[17]	Sharif S, Afsar A. Learning curve and minimally invasive spine surgery[J]. World Neurosurg, 2018, 119: 472-478.

显微镜辅助下MIS-TLIF治疗腰椎单节段退行性疾病的临床疗效观察

Clinical efficacy of MIS-TLIF assisted with microscope in treatment of lumbar single-segment degenerative diseases

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