摘要
目的:对比观察微创椎间融合术(MIS-TLIF)单侧与双侧固定治疗单间隙腰椎间盘突出症的临床疗效。方法:选择单间隙腰椎间盘突出症并实施MIS-TLIF 25例,其中单侧固定组12例、双侧固定组13例,观察记录两组手术时间、术中出血量、住院费用、临床疗效、并发症及椎间融合情况。结果:单侧固定组手术时间(148.33±9.37)min,非常显著短于双侧固定组的(213.85±24.51)min(P<0.01);单侧固定组术中出血(147.50±43.51)ml,显著少于双侧固定组的(226.92±69.57)ml(P<0.05);单侧固定组住院费用(4.38±0.20)万元,非常显著低于双侧固定组的(6.09±0.27)万元(P<0.01)。随访3个月至2年,两组患者腰腿痛症状均明显改善,总优良率均为100.0%;术后1个月可见椎间融合征象,术后3个月椎间基本融合,术后6个月所有患者融合满意;无神经根硬膜囊损伤、切口感染、融合器移位、内固定失效等并发症发生。结论:MIS-TLIF单侧固定创伤小、手术时间短、术中出血量较少、医疗成本低,临床疗效满意,是治疗单侧症状仅需单侧减压单间隙腰椎间盘突出症的一种可行方法。
引文
[1] Foley KT,Holly LT,Schwender JD.Minimally invasive lumbar fusion[J].Spine,2003,28(15Suppl):S26-S35.
[2]张绍东,王宸,陈辉,等.微创经椎间孔椎间融合术治疗腰椎退行性疾病[J].中华外科杂志,2009,47(2):112-115.
[3]顾广飞,张海龙,贺石生,等.微创经椎间孔腰椎体间融合术治疗腰椎管狭窄合并腰椎不稳症[J].中华外科杂志,2011,49(12):1081-1085.
[4]王建,周跃,张正丰,等.微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究[J].中华外科杂志,2011,49(12):1076-1080.
[5]王志荣,陆爱清,杨惠林,等.Quadrant通道下TLIF术治疗复发性腰椎间盘突出症的疗效分析[J].中国脊柱脊髓杂志,2014,24(2):121-126.
[6] Slucky AV,Brodke DS,Bachus KN,et al.Less invasive posterior fixation method following transforaminal lumbar interbody fusion:A biomechanical analysis[J].Spine J,2006,6(1):78-85.
[7] Xue H,Tu Y,Cai M.Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases[J].Spine J,2012,12(3):209-215.
[8]臧加成,马信龙,王涛,等.单侧与双侧椎弓根螺钉内固定在短节段腰椎融合手术中疗效比较的Meta分析[J].中华外科杂志,2012,50(9):848-853.
[9]陈立业,夏虹,王建华,等.双侧钉棒及同侧单钉棒置入内固定的生物力学比较[J].中国组织工程研究与临床康复,2011,15(48):8985-8988.
[10]Nakai O,Ookawa A,Yamaura I.Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis[J].J Bone Joint Surg Am,1991,73(8):1184-1191.
[11]高志强,李洋,罗飞.对脊柱椎间融合的影像学评价策略[J].中国组织工程研究,2015,19(48):7825-7830.
[12]周亮,刘郑生,毛克亚,等.MIS-TLIF与PLIF治疗单节段退行性腰椎疾病的肌肉损伤比较[J].解放军医学杂志,2013,38(12):972-975.
[13]罗志平,饶海群,黄大江,等.通道辅助下微创经椎间孔椎体间融合术治疗腰椎退行性疾病的疗效观察[J].中华医学杂志,2015,95(33):2681-2685.
[14]刘新宇,原所茂,田永昊,等.两种经椎间孔椎体间融合治疗单节段腰椎退行性疾病的疗效比较[J].中华创伤杂志,2015,31(6):507-511.
[15]黎庆初,胡辉林,刘宝戈,等.多裂肌间隙入路微创手术治疗腰椎滑脱症[J].中国脊柱脊髓杂志,2011,21(4):303-307.
[16]Lau D,Lee JG,Han SJ,et al.Complications and perioperative factor sassociated with learning the technique of minimally invasive transforaminal lumbar interbody fusion(TLIF)[J].J Clin Neurosci,2011,18(5):624-627.
[17]吴文坚,梁裕,张兴凯,等.微创腰椎经椎间孔椎体间融合术的并发症分析:131例病例回顾和文献复习[J].中国骨与关节外科,2012,5(2):103-108.
[18]肖波,毛克亚,王岩,等.微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术并发症的比较分析[J].脊柱外科杂志,2013,11(1):23-27.
[19]黄晓川,刘晖.Quadrant微创通道椎间融合内固定术与开放椎间融合内固定术治疗腰椎间盘突出症疗效的比较[J].中国骨与关节杂志,2014,3(4):257-260.
[20]龚志强,姜晓幸,冯振洲,等.腰椎单双侧椎弓根螺钉固定后的有限元分析比较[J].复旦学报(医学版),2013,40(2):187-192.
[21]Suk KS,Lee HM,Kim NH,et al.Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion[J].Spine(Phila Pa 1976),2000,25(14):1843-1847.
[22]周跃,王建,初同伟,等.内窥镜下经X-Tube单侧和双侧腰椎椎弓根螺钉固定的疗效评价[J].中华创伤杂志,2007,23(9):654-658.
[23]周少怀,方红育,李宏亮,等.单侧椎弓根钉联合椎体间融合器选择性治疗退行性腰椎病疗效观察[J].中华实验外科杂志,2015,32(9):2283-2285.
[24]蓝浩斌,苏红英,薛华.单侧与双侧椎弓根螺钉固定治疗单节段腰椎间盘突出症的疗效对比:一项长达四年的随机对照试验[J/CD].中华临床医师杂志(电子版),2016,10(9):1256-1261.
[25]周旭,丁悦,纪斌,等.单侧经皮椎弓根螺钉固定椎体间融合治疗多节段椎管狭窄[J].中国骨与关节杂志,2017,6(10):752-757.
[26]Choi UY,Park JY,Kim KH,et al.Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion[J].Neurosurg Focus,2013,35(2):E11.
[27]Lin B,Xu Y,He Y,et al.Minimally invasive unilateral pedicle screw fixation and lumbar interbody fusion for the treatment of lumbar degenerative disease[J].Orthopedics,2013,36(8):e1071-e1076.
[28]Silvestre C,Mac-Thiong JM,Hilmi R,et al.Complications and Morbidities of Min-open Anterior Retroperitoneal Lumbar Interbody Fusion:Oblique Lumbar Interbody Fusion in 179Patients[J].Asian Spine J,2012,6(2):89-97.
[29]Abe K,Orita S,Mannoji C,et al.Perioperative Complications in 155Patients Who Underwent Oblique Lateral Interbody Fusion Surgery:Perspectives and Indications From a Retrospective,Multicenter Survey[J].Spine(Phila Pa 1976),2017,42(1):55-62.
[30]王吉莹,周志杰,范顺武,等.斜外侧椎间融合术治疗腰椎退行性疾病的早期并发症分析[J].中华骨科杂志,2017,37(16):1006-1013.
[31]黄凯,刘展亮,刘少喻,等.腰椎单侧与双侧椎弓根螺钉固定的生物力学对比性研究[J/CD].中华临床医师杂志(电子版),2015,9(22):4143-4147.
