单侧经椎间孔外腰椎间融合术治疗中青年腰椎病变10例
摘要
目的:观察单侧经椎间孔外腰椎间融合内固定术(ELIF)治疗中青年腰椎病变的临床疗效。方法:回顾性分析2015年5月至2018年12月本院脊柱外科应用单侧固定ELIF技术治疗的10例单节段单侧症状腰椎病变患者资料。其中男6例,女4例;年龄38～50岁,平均42.2岁。根据手术时间、术中出血量、术后卧床时间、住院时间、术后并发症、手术前后腰疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)、影像学检查评定其疗效。术后2年确认融合理想,取出钉棒系统之后改为电话随访。结果:手术时间(91.3±10.8)min,术中出血量(127.5±9.3)mL,术后卧床时间(5.4±0.9)d,住院时间(12.0±1.5)d,无明显并发症。患者术后均获得随访,平均为27个月(24～32),术前、末次VAS及ODI评分均改善明显,差异有统计学意义(P<0.05)。内固定无移位且椎间融合理想。结论:对于中青年单节段单侧症状的腰椎病变运用单侧ELIF治疗,效果理想,可减少手术创伤,有利于患者术后早期康复。
引文
[1] 杜江.近五年腰椎间盘突出流行病学调查研究概况[J].临床医药文献电子杂志,2017,4(28):5529-5530.
[2] 鲁齐林,李绪贵,竺义亮,等.L4退变性滑脱术后再发L5真性滑脱1例[J].中国中医骨伤科杂志,2017,25(7):65-69.
[3] 詹吉恒,林定坤,王羽丰,等.腰椎后路内固定术后邻近节段退变与脊柱-骨盆矢状位参数的相关性分析[J].中国中医骨伤科杂志,2019,27(2):17-20.
[4] GOLOGORSKY Y,SKOVRLJ B,STEINBERGER J,et al.Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis:clinical article[J].J Neurosurg Spine,2014,21(4):601-607.
[5] RECOULES-ARCHE D,DRUSCHEL C,FAYADA P,et al.Unilateral extraforaminal lumbar interbody fusion(ELIF):surgical technique and clinical outcome in 107 patients[J].Clin Spine Surg,2016,29(3):162-170.
[6] 宋晓动,周红海,朱顺昌,等.脊柱整体性理论与临床相关研究概述[J].中华中医药杂志,2019,34(3):1134-1138.
[7] 朱小龙,徐卫星,盛红枫,等.透视引导下经椎间孔选择性神经根封闭治疗腰椎间盘突出症[J].中国中医骨伤科杂志,2017,25(4):47-49.
[8] ANDERSON D G.Critical evaluation of article:minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF-a prospective randomized clinical trial[J].Spine J,2016,16(7):820-821.
[9] 马凯,姜长明,杨群,等.保留脊柱后方韧带复合体腰椎管扩大术的基础研究与临床应用[J].中国修复重建外科杂志,2008,22(8):918-922.
[10] KURZBUCH A R,RECOULES-ARCHE D.Epidural fibrosis seen from a different angle:extraforaminal lumbar interbody fusion[J].J Neurol Surg A:Cent Eur Neurosurg,2017,78(1):82-86.
[11] 杨明杰,曾诚,李立钧,等.腰椎椎间孔外椎体间融合术的生物力学分析[J].同济大学学报:医学版,2018,39(4):51-55.
[12] 陈兵乾,张烽,董士奎,等.经椎间孔椎体间融合术即刻稳定性的生物力学研究[J].脊柱外科杂志,2006(5):281-283.
[13] ARTHUR R,KURZBUCH A,RECOULES-ARCHE D.Minimal invasive lumbar spine revision surgery at distance from the dura and postsurgical scar tissue:extraforaminal lumbar interbody fusion(ELIF)[J].Journal of Clinical Neuroscience,2018,47:332-336.
[14] KURZBUCH A R,KAECH D,BARANOWSKI P,et al.Extraforaminal lumbar interbody fusion at the L5-S1 level:technical considerations and feasibility[J].J Neurol Surg A:Cent Eur Neurosurg,2017,78(5):507-512.
[2] 鲁齐林,李绪贵,竺义亮,等.L4退变性滑脱术后再发L5真性滑脱1例[J].中国中医骨伤科杂志,2017,25(7):65-69.
[3] 詹吉恒,林定坤,王羽丰,等.腰椎后路内固定术后邻近节段退变与脊柱-骨盆矢状位参数的相关性分析[J].中国中医骨伤科杂志,2019,27(2):17-20.
[4] GOLOGORSKY Y,SKOVRLJ B,STEINBERGER J,et al.Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis:clinical article[J].J Neurosurg Spine,2014,21(4):601-607.
[5] RECOULES-ARCHE D,DRUSCHEL C,FAYADA P,et al.Unilateral extraforaminal lumbar interbody fusion(ELIF):surgical technique and clinical outcome in 107 patients[J].Clin Spine Surg,2016,29(3):162-170.
[6] 宋晓动,周红海,朱顺昌,等.脊柱整体性理论与临床相关研究概述[J].中华中医药杂志,2019,34(3):1134-1138.
[7] 朱小龙,徐卫星,盛红枫,等.透视引导下经椎间孔选择性神经根封闭治疗腰椎间盘突出症[J].中国中医骨伤科杂志,2017,25(4):47-49.
[8] ANDERSON D G.Critical evaluation of article:minimally invasive TLIF leads to increased muscle sparing of the multifidus muscle but not the longissimus muscle compared with conventional PLIF-a prospective randomized clinical trial[J].Spine J,2016,16(7):820-821.
[9] 马凯,姜长明,杨群,等.保留脊柱后方韧带复合体腰椎管扩大术的基础研究与临床应用[J].中国修复重建外科杂志,2008,22(8):918-922.
[10] KURZBUCH A R,RECOULES-ARCHE D.Epidural fibrosis seen from a different angle:extraforaminal lumbar interbody fusion[J].J Neurol Surg A:Cent Eur Neurosurg,2017,78(1):82-86.
[11] 杨明杰,曾诚,李立钧,等.腰椎椎间孔外椎体间融合术的生物力学分析[J].同济大学学报:医学版,2018,39(4):51-55.
[12] 陈兵乾,张烽,董士奎,等.经椎间孔椎体间融合术即刻稳定性的生物力学研究[J].脊柱外科杂志,2006(5):281-283.
[13] ARTHUR R,KURZBUCH A,RECOULES-ARCHE D.Minimal invasive lumbar spine revision surgery at distance from the dura and postsurgical scar tissue:extraforaminal lumbar interbody fusion(ELIF)[J].Journal of Clinical Neuroscience,2018,47:332-336.
[14] KURZBUCH A R,KAECH D,BARANOWSKI P,et al.Extraforaminal lumbar interbody fusion at the L5-S1 level:technical considerations and feasibility[J].J Neurol Surg A:Cent Eur Neurosurg,2017,78(5):507-512.