摘要
目的:探讨经皮内窥镜辅助下经椎间孔腰椎减压融合术(PE-TLIF)治疗单节段腰椎管狭窄症对腰椎多裂肌的影响。方法:回顾性分析2017年3月~2018年10月首都医科大学附属北京朝阳医院收治并采用PE-TLIF术式治疗的10例单节段腰椎管狭窄症患者,其中男3例,女7例,年龄43~73岁,平均59.4±11.5岁。记录手术时间、术中出血量、术后伤口引流量、术后卧床时间、并发症发生情况,并通过术前1d、术后7d、术后3个月、术后6个月的腰痛与腿痛视觉模拟评分(VAS)以及术前1d、术后3个月、术后6个月的Oswestry功能障碍指数(ODI)评分等指标评价临床疗效;采用Bridwell标准评估术后6个月植骨融合情况;通过术前1d、术后7d、术后3个月、术后6个月的切口处多裂肌的最大横截面积(Max-CSA)和六氟化硫微泡造影剂峰值强度(PI)及术前1d、术后1d、术后7d的血清肌酸激酶(CK)水平,评估腰椎多裂肌损伤情况。结果:患者手术时间292.5±54.0min,术中出血量119.0±92.4ml,术后伤口引流量39.5±19.5ml,术后卧床时间21.6±3.2h,手术切口长度8.7±1.8mm。术后6个月,7例患者获得Ⅱ级椎间融合,3例患者获得Ⅲ级椎间融合;术前1d、术后7d、术后3个月、术后6个月腰痛VAS分别为7.20±0.78分、4.10±0.73分、1.40±0.51分、1.10±0.87分,腿痛VAS分别为5.90±1.19分、2.20±1.22分、1.10±0.73分、0.90±0.87分。术前1d、术后3个月、术后6个月ODI评分分别为(53.3±12.1)%、(23.9±8.0)%、(13.5±6.5)%。术后不同随访时间点的VAS及ODI评分均较术前明显改善,差异有统计学意义(P<0.05);术前1d、术后1d、术后7d的血清CK水平别为79.3±30.3U/L、428.1±78.3U/L、96.2±21.4U/L。血清CK水平在术后1d较术前增高,差异有统计学意义(P<0.05),但在术后7d与术前比较无统计学差异(P>0.05);术前1d、术后7d、术后3个月、术后6个月的Max-CSA分别为501.7±127.6mm^2、624.7±101.8mm^2、521.5±60.4mm^2、494.5±62.6mm^2,以及PI
Objectives: To investigate the effects of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF) on multifidus muscle injury in the treatment of single-segment lumbar spinal stenosis. Methods: A retrospective analysis of 10 patients with single-segment lumbar spinal stenosis in the Beijing Chao-yang Hospital Affiliated to Capital Medical University from March 2017 to October 2018. There were 3 males and 7 females, whose mean age was 59.4±11.5 years old (range, 43-73 years old). All patients were treated with PE-TLIF. Operation time, intraoperative blood loss, postoperative wound drainage, postoperative bed rest time, complications were recorded. The clinical efficacy was evaluated using the VAS scores of low back pain and leg pain 1 day before surgery and 7 days, 3 and 6 months after surgery, and ODI scores 1 day before surgery and 3, 6 months after surgery. The Bridwell criteria were used to assess bone graft fusion 6 months after surgery. In order to evaluate the damage of the lumbar multifidus muscle, the maximal cross-sectional area(Max-CSA) of the multifidus muscle at the surgical incision and the peak intensity(PI) of sulphur hexafluoride microbubble contrast agent at 1 day before surgery, 7 days, 3 and 6 months after surgerywere calculated, and serum creatine kinase(CK) levels at 1 day before surgery, 1 and 7 days after surgery were also recorded. Results: The average operation time was 292.5±54.0min, the average intraoperative blood loss was 119.0±92.4ml, the average postoperative wound drainage volume 39.5±19.5ml, and the postoperative bed rest time 21.6±3.2h, surgical incision length 8.7±1.8mm. At 6 months follow-up, grade Ⅱ intervertebral fusion was obtained in 7 patients and grade Ⅲ intervertebral fusion was obtained in 3 patients. The VAS-LBP scores of 1 day before surgery, 7 days after surgery, 3 months after surgery, and 6 months after surgery were 7.20±0.78, 4.10±0.73, 1.40±0.51, 1.10±0.87, and VAS-LP scores were 5.90±1.19, 2.20±1.22, 1.10±0.73, 0.90±0.87 respect
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2019年第9期822-827,共6页
Chinese Journal of Spine and Spinal Cord
