摘要
目的探讨固定管径通道(microendoscopic discectomy,MED)辅助下微创经椎间孔椎间融合术(minimally in-vasive transforaminal lumbar interbody fusion,MIS-TLIF)与可扩张通道(Quadrant通道)辅助下MIS-TLIF治疗退变性腰椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)的临床疗效.方法回顾性分析2015年5月至2017年10月接受MIS-TLIF手术治疗59例退变性腰椎管狭窄症患者的病历资料.根据微创手术采用辅助通道的不同,将59例患者分为MED组(27例)与Quadrant组(32例),所有患者术后随访11~29个月,平均18.5个月.主要观察指标包括手术时间、术中出血量、术后引流量、术后卧床时间、术后肌酸激酶(creatine kinase,CK)变化程度、融合率、多裂肌萎缩程度、Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟评分(visual analogue score,VAS).结果MED组手术时间(161.7±22.4)min,相对于Quadrant组(145.6±19.4)min较长(t=4.541,P<0.01);MED组术中出血量(138.1±26.9)ml,较Quadrant组(155.6±21.5)ml减少(t=-2.724,P<0.01);MED组术后卧床时间(2.3±0.7)d,较Quadrant组(3.5±1.1)d缩短(t=-4.564,P<0.01).与Quadrant组相比,MED组术后第1、3天CK水平升高程度较低(P<0.01),术后第5天两组患者CK均恢复到正常水平.MED组术后第3天及12个月腰背痛VAS评分较Quadrant组降低(P<0.05);术后3个月两组VAS评分和ODI的差异均无统计学意义(P>0.05);术后6、12个月MED组ODI均低于Quadrant组(P<0.05).MED组融合率为88.9%(24/27),Quadrant组融合率为93.8%(30/32),两组的差异无统计学意义.术后1年MED组10例患者和Quadrant组12例患者复查腰椎MRI,测量多裂肌面积计算手术前后萎缩比,MED组为0.12±0.05,Quadrant组为0.22±0.04,MED组腰背肌肌肉萎缩程度较轻(t=-2.428,P<0.05).两组患者术中各发生1例硬脊膜囊破裂,即予明胶海绵联合纤维蛋白胶进行封堵,术后均未发生脑脊液漏;Quadrant组1例患者发生切口表皮坏死致延迟愈合,另1例发生脂肪液化.结
Objective To compare the clinical effects between minimally invasive transforaminal lumbar interbody fu-sion(MIS-TLIF)assisted by Microendoscopic discectomy(MED)and Quadrant for the treatment of degenerative lumbar spinal ste-nosis(DLSS).Methods All of 59 patients suffered from DLSS treated surgically from May 2015 to October 2017 were re-viewed.According to the surgery method,all cases were divided into MED group(27 cases)and Quadrant channel group(32 cases).All patients were followed up for an average of 18.5 months(11-29 months).Comparison was made on the operative time,intraoperative blood loss,postoperative drainage,postoperative time in bed,postoperative creatine kinase(CK),fusion rate and the degree of muscle fibrosis shown in MRI,as well as visual analogue scale(VAS)score and Oswestry dysfunction in-dex(ODI)score in two groups.Results The duration of operation in MED group was significantly longer than that in Quadrant group(161.7±22.4 min vs.145.6±19.4 min,t=4.541,P<0.01),but less intraoperative blood loss(138.1±26.9 ml vs.155.6±21.5 ml,t=-2.724,P<0.01)and shorter time in bed after surgery(2.3±0.7 d vs.3.5±1.1 d,t=-4.564,P<0.01).Compared with Quad-rant group,CK levels were risen slightly on the first and third postoperative day(P<0.01).CK on the fifth postoperative day in both groups returned to normal.VAS score of lower back pain in MED group was lower than that in Quadrant group on the third day and twelfth month after operation(P<0.05).After 3 months,there was no significant difference in VAS score and ODI between the two groups(P>0.05).ODI was lower in MED group than that in Quadrant group after 6 months and 12 months.The fusion rate was 88.9%(24/27)in MED group and 93.8%(30/32)in Quadrant channel group.There was no statistical difference in fusion rate of two groups.10 patients in MED group and 12 patients in Quadrant group underwent MRI examination of lumbar spine one year after operation.The ratio of postoperative and preoperative atrophy of multiplex muscle area was measured.Muscle atrophy
作者
李士学
张为
孙亚澎
张飞
崔浩
高原
李佳奇
李泽阳
王宪正
Li Shixue;Zhang Wei;Sun Yapeng;Zhang Fei;Cui Hao;Gao Yuan;Li Jiaqi;Li Zeyang;Wang Xianzheng(Dpartment of Spine Surgery,The Third Affiliated Hospital of Hebei Medical University,Shijiazhuang 050051,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第20期1275-1284,共10页
Chinese Journal of Orthopaedics
关键词
腰椎
椎间盘退行性变
椎管狭窄
外科手术
微创性
脊柱融合术
Lumbar vertebrae
Intervertebral disc degeneration
Spinal Stenosis
Surgical procedures,minimally invasive
Spinal fusion
