Quadrant通道辅助下微创经椎间孔减压腰椎融合固定术治疗单节段性腰椎病变的疗效研究
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摘要
目的探讨Quadrant通道辅助下微创经椎间孔减压腰椎融合固定术治疗单节段性腰椎病变的疗效。方法选择76例经保守治疗但情况未见好转的单一节段腰椎退变性疾病的患者进行前瞻性研究,将全部研究对象分为观察组和对照组,各38例。其中对照组行传统开放手术,观察组行Quadrant通道辅助下微创经椎间孔减压腰椎融合固定术。术后对两组患者进行为期2~3年的随访,平均随访时间(2.5±0.72)年,对患者的临床资料以及术后恢复情况进行分析和对比。结果 (1)两组患者术中手术时间、并发症、术后6个月、24个月融合率均差异无统计学意义(P=0.853,P=0.152,P=0.713,P=0.602);观察组患者中术中出血量、术后引流量相较于对照组有显著降低,且术后住院时间明显比对照组短,差异有统计学意义(均P<0.001);(2)两组患者术后1个月、24个月时的腰痛、腿痛VAS评分以及Oswestry功能障碍指数(Oswestry dysfunction index,ODI)均比术前有了明显下降,差异有统计学意义(均P<0.05),且呈逐渐降低趋势;观察组患者术后1个月腰痛、腿痛VAS评分均显著低于对照组(P<0.001,P=0.008);两组患者术后24个月腰痛、腿痛VAS评分以及术后1个月、24个月ODI差异无统计学意义(P=0.279,P=0.442,P=0.890,P=0.854);(3)两组患者术后肌酸磷酸激酶(CPK)较术前有了明显升高,且在术后1 d达到最高峰值,在术后7 d基本恢复正常,且观察组患者术后1、3 d的CPK明显低于对照组(均P<0.001),但两组患者术后5、7 d CPK差异无统计学意义(P=0.883,P=0.678);观察组患者术后3个月MRI测T2弛豫时间明显比对照组短,差异有统计学意义(P<0.001)。结论 Quadrant通道辅助下经椎间孔减压腰椎融合固定术的近期疗效与传统后路开放术一致,且具有肌肉、软组织损伤小以及早期功能恢复更加良好等优势。
Objective To explore the effect of minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel to cure single segment lumbar spine disease. Methods We selected 76 case of patients with single segment lumbar degenerative disease,whose conditions were not improved after treated with conservative treatment. All the subjects were randomized into observation group and control group,with 38 cases in each group. The control group was treated with traditional open surgery,while the observation group was treated with minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel. After operation,the patients were followed up for 2 to 3 years. The average follow-up time was( 2. 5 ± 0. 72) years. The clinical data and postoperative recovery of the patients were analyzed and compared. Results( 1) There were no significant differences in the operation time,complications,fusion rates 6 months and 24 months after surgery( P = 0. 853,P = 0. 152,P = 0. 713,P = 0. 602,respectively); Compared with the control group,the intraoperative blood loss,postoperative drainage volume in the observation group were significantly lower,and the postoperative hospital stay was significantly shorter,which indicated statistically significant differences( all P < 0. 001).( 2) One month and 24 months after surgery,the back pain,leg pain VAS score and ODI( Oswestry dysfunction index) of two groups were obviously lower than before surgery,which indicated statistically significant differences( all P < 0. 05),and showed a gradual decreasing trend. One month after surgery,the low back pain,leg pain VAS scores of the observation group were significantly lower than those of the control group( P <0. 001,P = 0. 008). There were no significant differences in the back pain,leg pain VAS score 24 months after surgery and ODI 1month and 24 months after surgery between the two group( P = 0. 279,P = 0. 442,P = 0. 890,P = 0. 854,respectively).( 3) The postoperative CPK of the two groups were significantly higher than those before operation,which reached the highest in 1 day after surgery,and returned to normal in 7 days after surgery. The CPK in 1 day and 3 days after surgery in the observation group were significantly lower than those in the control group,which indicated statistically significant difference( both P < 0. 001),but there was no significant difference in CPK 5 days and 7 days after surgery( P = 0. 883,P = 0. 678). Three months after operation,MRI relaxation time of T2 measurement in the observation group was significantly shorter than that in the control group( P < 0. 001). Conclusion The recent curative effect of minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel was consistent with traditional posterior approach,which had the advantages of less muscle,soft tissue injury and better early functional recovery.
Objective To explore the effect of minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel to cure single segment lumbar spine disease. Methods We selected 76 case of patients with single segment lumbar degenerative disease,whose conditions were not improved after treated with conservative treatment. All the subjects were randomized into observation group and control group,with 38 cases in each group. The control group was treated with traditional open surgery,while the observation group was treated with minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel. After operation,the patients were followed up for 2 to 3 years. The average follow-up time was( 2. 5 ± 0. 72) years. The clinical data and postoperative recovery of the patients were analyzed and compared. Results( 1) There were no significant differences in the operation time,complications,fusion rates 6 months and 24 months after surgery( P = 0. 853,P = 0. 152,P = 0. 713,P = 0. 602,respectively); Compared with the control group,the intraoperative blood loss,postoperative drainage volume in the observation group were significantly lower,and the postoperative hospital stay was significantly shorter,which indicated statistically significant differences( all P < 0. 001).( 2) One month and 24 months after surgery,the back pain,leg pain VAS score and ODI( Oswestry dysfunction index) of two groups were obviously lower than before surgery,which indicated statistically significant differences( all P < 0. 05),and showed a gradual decreasing trend. One month after surgery,the low back pain,leg pain VAS scores of the observation group were significantly lower than those of the control group( P <0. 001,P = 0. 008). There were no significant differences in the back pain,leg pain VAS score 24 months after surgery and ODI 1month and 24 months after surgery between the two group( P = 0. 279,P = 0. 442,P = 0. 890,P = 0. 854,respectively).( 3) The postoperative CPK of the two groups were significantly higher than those before operation,which reached the highest in 1 day after surgery,and returned to normal in 7 days after surgery. The CPK in 1 day and 3 days after surgery in the observation group were significantly lower than those in the control group,which indicated statistically significant difference( both P < 0. 001),but there was no significant difference in CPK 5 days and 7 days after surgery( P = 0. 883,P = 0. 678). Three months after operation,MRI relaxation time of T2 measurement in the observation group was significantly shorter than that in the control group( P < 0. 001). Conclusion The recent curative effect of minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel was consistent with traditional posterior approach,which had the advantages of less muscle,soft tissue injury and better early functional recovery.
引文
[1]Hey HWD,Hee HT.Open and minimally invasive transforaminal lumbar interbody fusion:Comparison of intermediate results and complications[J].Asian Spine Journal,2015,9(2):185-193.
[2]Phan K,Rao PJ,Kam AC,et al.Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:systematic review and meta-analysis[J].European Spine Journal,2015,24(5):1017-1030.
[3]刘自金,曹洪丽,王宁,等.微创与开放后路椎体间融合术治疗单节段退行性腰椎疾病对比研究[J].中国矫形外科杂志,2014,22(13):1158-1163.
[4]Sun ZJ,Wen Jing LI,Zhao Y,et al.Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:a meta-analysis[J].Chinese Medical Journal,2013,126(20):3962-3971.
[5]Tian NF,Wu YS,Zhang XL,et al.Minimally invasive versus open transforaminal lumbar interbody fusion:a meta-analysis based on the current evidence[J].European Spine Journal,2013,22(8):1741-1749.
[6]谢贵杰,廖士平,周骏武,等.单侧椎弓根螺钉固定联合TLIF技术治疗腰椎间盘突出症疗效分析[J].安徽医药,2013,17(12):2072-2074.
[7]Yee TJ,Terman SW,Marca FL,et al.Comparison of adjacent segment disease after minimally invasive or open transforaminal lumbar interbody fusion[J].Journal of Clinical Neuroscience,2014,21(10):1796-1801.
[8]吴大鹏,刘晓谭,徐海斌,等.X-Tube辅助下微创经椎间孔腰椎间融合术治疗退变性腰椎管狭窄症[J].中国现代医学杂志,2014,24(21):54-59.
[9]Darryl L,Adam K,Trman SW,et al.Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients[J].Neurosurgical Focus,2013,35(2):909-915.
[10]王强,吴寅良,朱和平,等.Mast Quadrant微创通道与开放式经椎间孔腰椎椎间融合术的临床比较[J].脊柱外科杂志,2013,11(5):288-291.
[11]Rodríguez-Vela J,Lobo-Escolar A,Joven E,et al.Clinical outcomes of minimally invasive versus open approach for one-level transforaminal lumbar interbody fusion at the 3-to 4-year follow-up[J].European Spine Journal,2013,22(12):2857-2863.
[12]Terman SW,Yee TJ,Lau D,et al.Comparison of clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion[J].American Association of Neurological Surgeons,2014,27(4):202-206.
[13]王长昇,林建华,许卫红,等.微创脊柱内镜系统辅助下改良椎间孔腰椎椎间融合术治疗腰椎间盘损伤[J].中华创伤杂志,2015,31(10):868-872.
[14]闫国良,纪振钢,高浩然,等.微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的疗效比较[J].中国脊柱脊髓杂志,2013,23(3):244-250.
[15]Nandyala SV,Marquez-Lara A,Jegier BJ,et al.A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion[J].Training&Education in Professional Psychology,2014,14(8):1694-1701.
[16]Zairi F,Arikat A,Allaoui M,et al.Transforaminal lumbar interbody fusion:Comparison between open and mini-open approaches with two years follow-up[J].Journal of Neurological Surgery Part A Central European Neurosurgery,2013,74(3):131-135.
[17]林景波,张洪涛,何平,等.经后路椎体间融合术与经椎间孔椎体间融合术治疗老年退行性腰椎滑脱合并腰椎管狭窄症的疗效[J].中国老年学杂志,2015,8(19):5568-5569.
[18]姬向兵,李靖,贾文博,等.不同手术入路方式治疗胸腰椎骨折的临床效果观察[J].安徽医学,2015,36(5):610-612.
[2]Phan K,Rao PJ,Kam AC,et al.Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:systematic review and meta-analysis[J].European Spine Journal,2015,24(5):1017-1030.
[3]刘自金,曹洪丽,王宁,等.微创与开放后路椎体间融合术治疗单节段退行性腰椎疾病对比研究[J].中国矫形外科杂志,2014,22(13):1158-1163.
[4]Sun ZJ,Wen Jing LI,Zhao Y,et al.Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:a meta-analysis[J].Chinese Medical Journal,2013,126(20):3962-3971.
[5]Tian NF,Wu YS,Zhang XL,et al.Minimally invasive versus open transforaminal lumbar interbody fusion:a meta-analysis based on the current evidence[J].European Spine Journal,2013,22(8):1741-1749.
[6]谢贵杰,廖士平,周骏武,等.单侧椎弓根螺钉固定联合TLIF技术治疗腰椎间盘突出症疗效分析[J].安徽医药,2013,17(12):2072-2074.
[7]Yee TJ,Terman SW,Marca FL,et al.Comparison of adjacent segment disease after minimally invasive or open transforaminal lumbar interbody fusion[J].Journal of Clinical Neuroscience,2014,21(10):1796-1801.
[8]吴大鹏,刘晓谭,徐海斌,等.X-Tube辅助下微创经椎间孔腰椎间融合术治疗退变性腰椎管狭窄症[J].中国现代医学杂志,2014,24(21):54-59.
[9]Darryl L,Adam K,Trman SW,et al.Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients[J].Neurosurgical Focus,2013,35(2):909-915.
[10]王强,吴寅良,朱和平,等.Mast Quadrant微创通道与开放式经椎间孔腰椎椎间融合术的临床比较[J].脊柱外科杂志,2013,11(5):288-291.
[11]Rodríguez-Vela J,Lobo-Escolar A,Joven E,et al.Clinical outcomes of minimally invasive versus open approach for one-level transforaminal lumbar interbody fusion at the 3-to 4-year follow-up[J].European Spine Journal,2013,22(12):2857-2863.
[12]Terman SW,Yee TJ,Lau D,et al.Comparison of clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion[J].American Association of Neurological Surgeons,2014,27(4):202-206.
[13]王长昇,林建华,许卫红,等.微创脊柱内镜系统辅助下改良椎间孔腰椎椎间融合术治疗腰椎间盘损伤[J].中华创伤杂志,2015,31(10):868-872.
[14]闫国良,纪振钢,高浩然,等.微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的疗效比较[J].中国脊柱脊髓杂志,2013,23(3):244-250.
[15]Nandyala SV,Marquez-Lara A,Jegier BJ,et al.A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion[J].Training&Education in Professional Psychology,2014,14(8):1694-1701.
[16]Zairi F,Arikat A,Allaoui M,et al.Transforaminal lumbar interbody fusion:Comparison between open and mini-open approaches with two years follow-up[J].Journal of Neurological Surgery Part A Central European Neurosurgery,2013,74(3):131-135.
[17]林景波,张洪涛,何平,等.经后路椎体间融合术与经椎间孔椎体间融合术治疗老年退行性腰椎滑脱合并腰椎管狭窄症的疗效[J].中国老年学杂志,2015,8(19):5568-5569.
[18]姬向兵,李靖,贾文博,等.不同手术入路方式治疗胸腰椎骨折的临床效果观察[J].安徽医学,2015,36(5):610-612.