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
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摘要
目的评价微创经椎间孔腰椎体间融合术(MIS-TLIF)和开放经椎间孔腰椎间融合术(TLIF)治疗单节段退变性腰椎管狭窄症的临床效果。方法自2009年1月~2011年3月,56例单节段退变性腰椎管狭窄症患者进行双侧METRxTMX-Tube辅助下MIS-TLIF或后路开放TLIF手术,采用X-Tube辅助扩张通道下MIS-TLIF治疗患者22例(MIS-TLIF组),传统开放TLIF方法治疗患者34例(TLIF组)。分析两组手术时间、手术出血量、术中X线照射时间、术后平均住院时间和并发症等方面的差异,采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评分评估临床结果,行X线片评价椎间融合情况,术后末次随访时采用MacNab标准评价临床效果。结果所有患者均获得随访。两组术前一般资料,VAS和ODI评分无显著性差异。术后两组各出现1例硬膜囊撕裂,术后脑脊液漏,拔管后脑脊液漏即停止,无其他并发症发生,MIS-TLIF组手术时间和术中X线照射时间多于TLIF组(P<0.01),手术出血量MIS-TLIF组明显低于TLIF组(P<0.01)。术后平均住院日MIS-TLIF组明显短于TLIF组(P<0.01)。术后两组VAS和ODI评分相比均无显著性差异(P>0.05),术后X线评价融合率和末次随访临床效果优良率两组亦无显著性差异(P>0.05)。结论与传统开放手术相比,X-Tube辅助下微创经椎间孔腰椎体间融合术治疗单节段退变性腰椎管狭窄症也可以获得相同的效果,并具有创伤小、恢复快的优点。
【Objective】To evaluate the clinical outcomes of minimally invasive transforminal lumbar interbody fusion(MIS-TLIF) and open transforaminal lumbar interbody fusion(TLIF) for single-level degeneration lumbar stenosis. 【Methods】From Jan 2009 to March 2011, 56 patients of single-level degeneration lumbar stenosis with MISTLIF under double side METRxTM X-Tube system and TLIF. There were 20 males and 36 females,the mean age was 53 years(range, 38~70years). There were 22 patients who underwent minimally invasive transforminal lumbar interbody fusion by X-Tube system(MIS-TLIF), 34 patients who underwent open transforaminal lumbar interbody fusion(TLIF). The operative time, blood loss, X-ray exposure time,bed time and complications were compared between the two groups. Clinical outcome was assessed using the visual analog scale(VAS) and the Oswestry disability index(ODI). Fusion rates were determined by X-ray examination and clinical outcomes were determined using MacNab criterion in last fellow-up.【Results】All patients were followed up, there was no difference with respect to pre-operative demographic date, VAS and ODI scores between two groups.There was 1 case complicated with dural tear in each group,which all were followed by cerebrospinal fluid leakage after operation and stop after extubation,and no other complications.MIS-TLIF group had longer operative time and X-ray exposure time than TLIF group(P <0.01),but less operative blood loss than TLIF group(P <0.01), MIS-TLIF group had shorter postoperative bed time than TLIF group(P <0.01). There was no difference between two groups with VAS and ODI scores(P >0.05), the same results with fusion rates and clinical outcomes in last fellow-up(P >0.05). 【Conclusions】Compared with regular opening way, minimally invasive transforminal lumbar interbody fusion under X-Tube system for single-level degeneration lumbar stenosis has the similar outcomes,but it can minimize tissue trauma and shorter recovery time.
【Objective】To evaluate the clinical outcomes of minimally invasive transforminal lumbar interbody fusion(MIS-TLIF) and open transforaminal lumbar interbody fusion(TLIF) for single-level degeneration lumbar stenosis. 【Methods】From Jan 2009 to March 2011, 56 patients of single-level degeneration lumbar stenosis with MISTLIF under double side METRxTM X-Tube system and TLIF. There were 20 males and 36 females,the mean age was 53 years(range, 38~70years). There were 22 patients who underwent minimally invasive transforminal lumbar interbody fusion by X-Tube system(MIS-TLIF), 34 patients who underwent open transforaminal lumbar interbody fusion(TLIF). The operative time, blood loss, X-ray exposure time,bed time and complications were compared between the two groups. Clinical outcome was assessed using the visual analog scale(VAS) and the Oswestry disability index(ODI). Fusion rates were determined by X-ray examination and clinical outcomes were determined using MacNab criterion in last fellow-up.【Results】All patients were followed up, there was no difference with respect to pre-operative demographic date, VAS and ODI scores between two groups.There was 1 case complicated with dural tear in each group,which all were followed by cerebrospinal fluid leakage after operation and stop after extubation,and no other complications.MIS-TLIF group had longer operative time and X-ray exposure time than TLIF group(P <0.01),but less operative blood loss than TLIF group(P <0.01), MIS-TLIF group had shorter postoperative bed time than TLIF group(P <0.01). There was no difference between two groups with VAS and ODI scores(P >0.05), the same results with fusion rates and clinical outcomes in last fellow-up(P >0.05). 【Conclusions】Compared with regular opening way, minimally invasive transforminal lumbar interbody fusion under X-Tube system for single-level degeneration lumbar stenosis has the similar outcomes,but it can minimize tissue trauma and shorter recovery time.
引文
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[12]WEAM C,MUN W,YEW S,et al.Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion[J].Spine,2009,34(13):1385-1389.
[13]KIM DY,LEE SH,CHUNG SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:pereutaneous versus open pedicles screw fixation[J].Spine,2005,30(1):123-129.
[14]杨洪宇,欧云生,权正学,等.比较经椎旁肌间隙入路与传统开放入路置入椎弓根螺钉治疗胸腰椎骨折的疗效[J].中国现代医学杂志,2011,21(27):3421-3424.[14]YANG HY,OU YS,QUAN ZX,et al.The comparison of paraspinal approach and traditional open approach treatment for thoracolumbar fractures with fixation using pedicle screw[J].China Journal of Modern Medicine,2011,21(27):3421-3424.Chinese
[15]MEYER SA,WU JC,MUMMANENI PV.Mini-open and minimally invasive transforaminal lumbar interbody fusion:technique review[J].Semin Spine Surg,2011,23:45-50.
[16]KIM CW,LEE YP,TAYLOR W,et al.Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive.spine surgery[J].Spine J,2008,8(4):584-590.
[17]PARK Y,HA JW,LEE YT,et al.The effect of a radiographic solid fusion on clinical outcomes after minimally invasive transforaminal lumbar interbody fusion[J].Spine J,2011,11:205-212.
[2]DJURASOVIC M,GLASSMAN SD,CARREON LY,et al.Contemporary management of symptomatic lumbar spinal stenosis[J].Orthop Clin North Am,2010,41(2):183-191.
[3]WEINSTEIN JN,TOSTESON TD,LURIE JD,et al.Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial[J].Spine,2010,35(14):1329-1338.
[4]BRIDWELL KH,LENKE LG,MCENERY KW,et al.Anterior fresh frozen 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,1995,20(12):1410-1418.
[5]李卫东,崔志明,徐冠华,等.Mast Quadrant可扩张管通道微创手术系统治疗腰椎管狭窄症[J].脊柱外科杂志,2010,8(4):207-210.[5]LI WD,CUI ZM,XU GH,et al.Minimally invasive surgery for the management of lumbar spinal stenosis assisted by Mast Quadrant system[J].J Spinal Surg,2010,8(4):207-210.Chinese
[6]BARZ T,MELLOH M,STAUB LP,et al.Nerve root sedimentation sign:evaluation of a new radio-logical sign in lumbar spinal stenosis[J].Spine,2010,35(8):892-897.
[7]DEYO RA,MIRZA SK,MARTIN BI,et al.Trends major medical complications,and charges associated with surgery for lumbar spinal stenosis in older adults[J].JAMA,2010,303(13):1259-1265.
[8]ADACHI K,FUTAMI T,EBIHARA A,et al.Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis[J].Spine J,2003,3(6):471-478.
[9]WEINSTEIN JN,TOSTESON TD,LURIE JD,et al.Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial[J].Spine,2010,35(14):1329-1338.
[10]范顺武,胡志军,方向前,等.小切口与传统开放术式行后路腰椎椎体间融合术对脊旁肌损伤的对比研究[J].中华骨科杂志,2009,29(11):1000-1004.[10]FAN SW,HU ZJ,FANG XQ,et al.Comparison of paraspinal muscle injury about one-level lumbar posterior intervertebral fusion performed with minimally invasive or conventional open approach[J].Chinese Journal Of Orthopaedics,2009,29(11):1000-1004.Chinese
[11]刘彦斌,贺石生,李明.微创腰椎融合术的研究进展[J].中国脊柱脊髓杂志,2009,19(5):395-398.[11]LIU YB,HE SS,LI M.Research progress of minimally invasive lumbar interbody fusion[J].Chinese Journal of Spinal Cord,2009,19(5):395-398.Chinese
[12]WEAM C,MUN W,YEW S,et al.Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion[J].Spine,2009,34(13):1385-1389.
[13]KIM DY,LEE SH,CHUNG SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:pereutaneous versus open pedicles screw fixation[J].Spine,2005,30(1):123-129.
[14]杨洪宇,欧云生,权正学,等.比较经椎旁肌间隙入路与传统开放入路置入椎弓根螺钉治疗胸腰椎骨折的疗效[J].中国现代医学杂志,2011,21(27):3421-3424.[14]YANG HY,OU YS,QUAN ZX,et al.The comparison of paraspinal approach and traditional open approach treatment for thoracolumbar fractures with fixation using pedicle screw[J].China Journal of Modern Medicine,2011,21(27):3421-3424.Chinese
[15]MEYER SA,WU JC,MUMMANENI PV.Mini-open and minimally invasive transforaminal lumbar interbody fusion:technique review[J].Semin Spine Surg,2011,23:45-50.
[16]KIM CW,LEE YP,TAYLOR W,et al.Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive.spine surgery[J].Spine J,2008,8(4):584-590.
[17]PARK Y,HA JW,LEE YT,et al.The effect of a radiographic solid fusion on clinical outcomes after minimally invasive transforaminal lumbar interbody fusion[J].Spine J,2011,11:205-212.