[1]杨晶晶 张志文 熊侃△ 何承建△.经椎间孔腰椎椎间融合术治疗腰椎间盘突出症32例[J].中国中医骨伤科杂志,2021,29(10):65-68.
　YANG Jingjing ZHANG Zhiwen XIONG Kan HE Chengjian.32 Cases of Clinical Efficacy of MIS-TLIF in theTreatment of Lumbar Disc Herniation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(10):65-68.
点击复制

经椎间孔腰椎椎间融合术治疗腰椎间盘突出症32例()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年10期
页码:
65-68
栏目:
临床报道
出版日期:
2021-10-15

文章信息/Info

Title:
32 Cases of Clinical Efficacy of MIS-TLIF in theTreatment of Lumbar Disc Herniation
文章编号:
1005-0205(2021)10-0065-04
作者:
杨晶晶1 张志文2; 3 熊侃4△ 何承建2; 3△
1湖北中医药大学针灸骨伤学院(武汉,430061)2湖北省中医院骨伤科3湖北省中医药研究院4武汉市江夏区中医院
Author(s):
YANG Jingjing1 ZHANG Zhiwen2; 3 XIONG Kan4△ HE Chengjian2; 3△
1College of Acupuncture and Orthopedics,Hubei University of Traditional Chinese Medicine,Wuhan 430061,China; 2Department of Orthopedics and Traumatology,Hubei Hospital of Traditional Chinese Medicine,Wuhan 430061,China; 3Hubei Province Academy of Traditional Chinese Medicine,Wuhan 430074,China; 4Jiangxia District Hospital of Traditional Chinese Medicine,Wuhan 430200,China.
关键词:
经椎间孔椎间融合术;  微创性;  腰椎间盘突出症;  效果
Keywords:
transforaminal interbody fusion;  minimally invasive;  lumbar disc herniation;  effect
分类号:
R681.5
文献标志码:
B
摘要:
目的:探讨微创经椎间孔腰椎椎间融合术(MIS-TLIF)治疗腰椎间盘突出症的临床疗效。方法:回顾性分析2017年1月至2019年6月采用MIS-TLIF治疗的32例腰椎间盘突出症患者,收集患者手术时间、术中出血量、术后引流量、椎间融合率及术后相关并发症,记录手术前后的椎间隙高度(DH)、腰椎前凸角(LL)、融合节段角(FSA)、疼痛视觉模拟量表评分(VAS)及Oswestry功能障碍指数(ODI)。结果:32例患者随访12～15个月,平均12.9个月。手术时间为(191.34±42.34)min(123～269 min),术中出血量为(154.38±42.14)mL(97～262 mL),术后引流量为(61.03±19.21)mL(32～94 mL)。术后切口浅表感染1例,经保守治疗痊愈; 置钉位置不佳1例,末次随访时未出现不适。术后不同时点的VAS评分、ODI均较术前显著改善,差异均有统计学意义(P<0.05); 随术后时间推移,VAS评分及ODI持续下降,差异有统计学意义(P<0.05)。影像学方面,术后1周及术后12个月的DH、LL、FSA均较术前显著改善,差异有统计学意义(P<0.05); 术后1周上述指标和术后12个月比较,差异均无统计学意义(P>0.05)。随访期间椎间融合率为90.62%,未发现融合器移位、下沉及内固定装置松动断裂等情况。结论:MIS-TLIF治疗腰椎间盘突出症能解除神经压迫,恢复椎间隙高度和脊柱稳定性,改善患者生活质量,具有创伤小、出血少、术后恢复快等优势,疗效确切。
Abstract:
Objective:To explore the clinical effect of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of lumbar disc herniation.Methods:32 patients with lumbar disc herniation treated by MIS-TLIF from January 2017 to June 2019 were analyzed retrospectively.The operation time,intraoperative blood loss,postoperative drainage,interbody fusion rate and postoperative complications were collected.The height of intervertebral space(DH),lumbar kyphosis angle(LL),fusion segment angle(FSA),pain visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were recorded before and after operation.Results:32 patients were followed up for 12 to 15 months,with an average of 12.9 months.The operation time was(191.34±42.34)min(123 to 269 min),intraoperative blood loss was(154.38±42.14)ml(97 to 262 mL),postoperative drainage was(61.03±19.21)mL(32 to 94 mL).Postoperative superficial incision infection occurred in 1 case,which was cured by conservative treatment,and poor nail placement was found in 1 case,and there was no discomfort at the last follow-up.The VAS score and ODI at different time points after operation were significantly improved as compared with those before operation(P<0.05),and the VAS score and ODI decreased continuously with the passage of time after operation(P<0.05).In terms of imaging,DH,LL and FSA at 1 week and the last follow-up were significantly improved as compared with those before operation(P<0.05),but there was no significant difference between the above indexes at 1 week after operation and 1 year after operation(P>0.05).During the follow-up period,the interbody fusion rate was 90.62%,and no cage displacement,subsidence,loosening and fracture of the internal fixation device were found.Conclusion:MIS-TLIF treatment of lumbar disc herniation can relieve nerve compression,effectively restore the height of intervertebral space and spinal stability,and improve the quality of life of patients.It has the advantages of less trauma,less bleeding and rapid recovery after operation.

参考文献/References:

[1] LIN G X,PARK C K,HUR J W,et al.Time course observation of outcomes between minimally invasive transforaminal lumbar interbody fusion and posterior lumbar interbody fusion[J].Neurol Med Chir(Tokyo),2019,59(6):222-230.
[2] 何勇,魏国俊,黄晋,等.开放和微创经椎间孔融合术治疗腰椎间盘突出症对椎旁肌变化的影响[J].中国中医骨伤科杂志,2017,25(1):26-29.
[3] 陈漩,李野,赵海洋,等.微创经椎间孔、极外侧、斜外侧入路腰椎椎间融合术的适应证及并发症研究进展[J].脊柱外科杂志,2020,18(6):419-424.
[4] HUSKISSON E C.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[5] FAIRBANK J C, PYNSENT P B.The oswestry disability index[J].Spine(Phila Pa 1976),2000,25(22):2940-2952.
[6] BRIDWELL K H, LENKE L G, MCENERY K W,et al.Anterior fresh frozen structural allografts in the thoracic and lumbar spine.Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?[J].Spine(Phila Pa 1976),1995,20(12):1410-1418.
[7] 霍启凡,吴骏,吴德逻,等.双侧MIS-TLIF治疗单节段退变性腰椎滑脱症的临床疗效[J].局解手术学杂志,2018,27(10):728-733.
[8] GE D H, STEKAS N D, VARLOTTA C G,et al.Comparative analysis of two transforaminal lumbar interbody fusion techniques:open TLIF versus Wiltse MIS TLIF[J].Spine(Phila Pa 1976),2019,44(9):E555-E560.
[9] 吴晓淋,丛文斌,钟鑫,等.微创经椎间孔入路腰椎椎体间融合术对腰椎多裂肌影响的MRI评估[J].中华骨科杂志,2020,40(14):902-910.
[10] 聂治军,袁启令,张文芳,等.显微镜辅助下微创与开放经椎间孔腰椎间融合术治疗单节段腰椎退行性疾病的疗效比较[J].中华骨与关节外科杂志,2020,13(3):219-224.
[11] 荚龙,曾至立,于研,等.固定通道下微创经椎间孔腰椎椎间融合术治疗单节段腰椎退行性疾病的临床疗效[J].中华骨科杂志,2018,38(20):1258-1265.
[12] 陈龙,竺义亮,李绪贵,等.单侧经椎间孔外腰椎间融合术治疗中青年腰椎病变10例[J].中国中医骨伤科杂志,2019,27(6):66-68.
[13] 林伟文,赖茂松,熊浩,等.单侧与双侧椎弓根螺钉联合微创经椎间孔椎体间融合术治疗腰椎退行性疾病的临床疗效和影像学比较[J].中国实用医药,2019,14(20):62-65.
[14] 于圣会,罗干,陈果,等.单侧MIS-TLIF治疗极外侧腰椎间盘突出症[J].中国矫形外科杂志,2019,27(21):1926-1930.
[15] 张征石,陈勇,钱红兵,等.单侧与双侧经皮椎弓根固定微创TLIF的比较[J].中国矫形外科杂志,2017,25(21):1944-1948.
[16] 王晓东,刘璞,王清和.乳突“斜坡”进钉在腰椎椎间植骨融合内固定术L5置钉的应用价值[J].中国中医骨伤科杂志,2020,28(8):73-75.

备注/Memo

备注/Memo:
△通信作者 E-mail:1192894226@qq.com
更新日期/Last Update: 1900-01-01