摘要
目的探讨显微内窥镜(MED)下经皮椎弓根螺钉微创经椎间孔入路椎间融合术(MIS-TLIF)治疗单节段腰椎间盘突出伴腰椎不稳症的临床疗效。方法将2012年1月至2015年1月莆田学院附属医院微创脊柱外科收治的经X线片、CT和MRI检查等明确诊断为单节段腰椎间盘突出伴腰椎不稳症,无严重器官功能障碍或系统性疾病的患者65例。30例患者纳入A组,采用MED下髓核摘除+椎间植骨融合+经皮椎弓根螺钉内固定治疗。35例患者纳入B组,采用Quadrant通道下腰椎双侧Wiltse入路MIS-TLIF术。比较两组患者手术时间、出血量、术后住院时间、置钉准确性、融合率、术前术后疼痛评分、临床疗效。结果A组和B组手术时间分别为(102.1±5.5)min和(103.7±7.7)min(t=-0.586,P〉0.05);A组和B组术中出血量、术后住院时间分别为(44.6±5.2)ml和(57.2±5.3)ml,(7.3±1.6)d和(9.3±1.9)d(t分别为-5.813、-2.774,均P〈0.05)。A组植入120颗椎弓根螺钉,B组植入140颗椎弓根螺钉,A组优良率为97.5%,B组优良率为95.7%(χ2=3.00,P〉0.05)。A组术后3个月融合率为96.7%(29/30),B组术后3个月融合率为94.3%(33/35)(χ2=0.79,P〉0.05)。A组和B组术前、术后3个月日本骨科协会评估治疗评分(JOA)分别为(20.4±2.4)分和(7.9±1.0)、(19.1±2.7)分和(7.8±1.2)分;A组、B组术前JOA评分相比,术后JOA评分相比,差异无统计学意义(t分别为1.242、0.178,均P〉0.05);A组术前、术后JOA评分;B组术前、术后JOA评分差异有统计学意义(P〈0.05)。两组患者术后临床疗效优良率A组为84.4%(25/30),B组为80.0%(28/35),差异无统计学意义(χ2=0.43,P〉0.05)。结论MED下经皮螺钉MISS-TLIF术为相对常规脊柱微创手术,创伤小,操作便捷,临床疗效确切,是一种可行、可靠的微创手术方式,值得推广。
ObjectiveTo evaluate the clinical efficacy between the minimally-Invasive surgical (MIS)-transforaminal lumbar interbody fusion (TLIF) technique associated with percutaneous pedicle screws in micro endoscopy discectomyand MIS-TLIF technique associated with both sides of the lower lumbar spine Wiltse approach in Quadrant channel with treatment of single segment herniation associated with lumbar instability syndrome.
MethodsFrom January 2012 to January 2015, 75 cases that meet the inclusion and exclusion criteria were treated by retrospective study method, which were divided into two groups in Department of Orthopedics, the Affiliated Hospital of Putian University.Experimental group(30 patients) were treated with MIS-TLIF technique associated with percutaneous pedicle screws in microendoscopy discectomy, control group were treated with MIS-TLIF technique associated with both sides of the lower lumbar spine Wiltse approach in Quadrant Chanel.Compare operation time, blood loss, postoperativehospital stay, clinical efficacy, nailing accuracy, fusion rate, postoperative pain scoring of two groups.
ResultsThe blood loss[(102.1±5.5) min vs(103.7±7.7) min, t=-0.586, P〉0.05], postoperative blood loss, hospital stay[(44.6±5.2) ml and(57.2±5.3) ml, (7.3±1.6) d and(9.3±1.9) d; t=-5.813, -2.774, P〈0.05], JOA score before and after surgery in same group were statistically significant(P〈0.05), respectively.Patients of two groups compared with operation time, clinical efficacy, nailing accuracy[group A: 97.5%, group B: 95.7%; χ2=3.00, P〉0.05.Postoperative 3 month , group A: 96.7%(29/30), group B: 94.3%(33/35; χ2=0.79, P〉0.05], fusion rate[group A: 96.7%(29/30), group B: 94.3%(33/35), χ2=0.79, P〉0.05], preoperative JOA score[(20.4±2.4)score and(7.9±1.0), (19.1±2.7)score and(7.8±1.2)score], postoperative JOA score were no statistically significant respectively, P〉0.05. JOA score of both groups were statistically signif
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第11期864-868,共5页
National Medical Journal of China
关键词
椎间盘移位
显微外科手术
脊柱融合术
经皮椎弓根螺钉
Intervertebral disk dispiacement
Microsurgery
Spine fusion
Percutaneouspedicle screw