Mast Quadrant通道与开放式经椎间孔腰椎融合术治疗单节段腰椎间盘突出症的前瞻性随机对照研究
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摘要
目的通过比较Mast Quadrant通道与开放式经椎间孔腰椎融合术治疗单节段腰椎间盘突出症有效性及安全性,验证Mast Quadrant通道治疗腰椎间盘突出症的长期有效性。方法 2009年1月至2010年12月就诊于我院的单节段腰椎间盘突出症患者随机分为两组,分别进行Mast Quadrant通道(微创组)与开放式(常规组)经椎间孔腰椎融合术。术后对受试者随访4年以上,并对术中相关指标及术后观察结果进行随访比较。通过统计学软件对两组的观察指标进行比较分析。结果微创组28例,常规组25例,进行至少4年的随访。微创组和常规组相比较,术中失血量少,早期VAS评分及ODI下降快,远期VAS评分及ODI无明显统计学差异。术后3个月微创组的T2弛豫时间显著低于常规组[(48±12)ms vs.(83±23)ms,P<0.000 01],术区周围的肌肉组织水肿消退早。但是微创组术中需要反复的透视[(103±27)s vs.(34±18)s,P<0.000 01],比常规组医护人员的射线暴露量增加。结论 Mast Quadrant通道和开放式经椎间孔腰椎融合术治疗腰椎间盘突出症的远期疗效相当,二者在长期VAS评分、ODI、二次手术率上无明显差异。不同的是,Mast Quadrant通道手术优点是术中失血量少、术后的疼痛缓解快,功能康复早,缺点是术中的透视时间长。这就需要我们在选择手术方式的过程中权衡利弊,采用合适的术式。
Objective To verify the effectiveness and safety of quadrant retractor surgery in long period, we conducted this randomized controlled study, which compared the quadrant retractor versus open surgery transforaminal lumbar interbody fusion(TLIF) for single level lumbar disc spondylosis patients. Methods From January 2009 to December 2010, 58 patients with single level lumbar disc spondylosis were enrolled and divided into two groups randomly. Then we followed up for at least 4 years. The outcome measures included the operation time, the volume of blood loss, Visual Analogue Scale, Oswestry disability index, T2 relax time of MRI and rate of re-operation. Results There were significant differences between the two treatment groups on the blood loss, early Visual Analogue Scale and Oswestry disability index, T2 relax time. There was no significant difference on late Visual Analogue Scale and Oswestry disability index, incidence of secondary surgery. Conclusion Quadrant retractor surgery and open surgery transforaminal lumbar interbody fusion are both effective in improving clinical status. Differently, the early Visual Analogue Scale and Oswestry disability index are relatively better preserved in Quadrant retractor surgery than open surgery. Quadrant retractor surgery is safe enough as an encouraging safe alternative to open TLIF surgery.
Objective To verify the effectiveness and safety of quadrant retractor surgery in long period, we conducted this randomized controlled study, which compared the quadrant retractor versus open surgery transforaminal lumbar interbody fusion(TLIF) for single level lumbar disc spondylosis patients. Methods From January 2009 to December 2010, 58 patients with single level lumbar disc spondylosis were enrolled and divided into two groups randomly. Then we followed up for at least 4 years. The outcome measures included the operation time, the volume of blood loss, Visual Analogue Scale, Oswestry disability index, T2 relax time of MRI and rate of re-operation. Results There were significant differences between the two treatment groups on the blood loss, early Visual Analogue Scale and Oswestry disability index, T2 relax time. There was no significant difference on late Visual Analogue Scale and Oswestry disability index, incidence of secondary surgery. Conclusion Quadrant retractor surgery and open surgery transforaminal lumbar interbody fusion are both effective in improving clinical status. Differently, the early Visual Analogue Scale and Oswestry disability index are relatively better preserved in Quadrant retractor surgery than open surgery. Quadrant retractor surgery is safe enough as an encouraging safe alternative to open TLIF surgery.
引文
[1]Rosenberg WS,Mummaneni PV.Transforaminal lumbar interbody fusion:technique,complications,and early results[J].Neurosurgery,2001,48(3):569-574.
[2]Foley KT,Lefkowitz MA.Advances in minimally invasive spine surgery[J].Clin Neurosurg,2002,49:499-517.
[3]王强,吴寅良,朱和平.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.
[4]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.
[5]黄晓川,刘晖.微创通道椎间融合内固定术与开放椎间融合高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.
[6]Mc Cormack HM,del Horne DJ,Sheather S.Clinical applications of visual analogue scales:a critical review[J].Psychol Med,1998,18(4):1007-1019.
[7]Blume HG,Rojas CH.Unilateral lumbar interbody fusion(posterior approach)utilizing dowel graft[J].Neurol Orthop Surg,1981,2:171-175.
[8]成浩,徐建广.TLIF技术的临床应用与进展[J].中国矫形外科杂志,2008,20:1560-1601.
[9]Rouben D,Casnellie M,Ferguson M.Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion:a clinical and radiographic follow-up[J].Spinal Disord Tech,2011,24(5):288-296.
[10]Glassman SD,Copay AG,Berven SH,et al.Defining substantial clinical benefit following lumbar spine arthrodesis[J].J Bone Joint Surg Am,2008,90(9):1839-1847.
[11]邵诗泽,张恩忠,付松谭,等.腰骶段多裂肌的形态特点及功能意义[J].中国临床解剖学杂志,2010,1:17-19.
[12]陈国平,洪天禄,李淑葵,等.多裂肌间隙入路手术治疗腰椎手术失败综合征[J].实用骨科杂志,2013,4:289-293.
[13]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.
[14]Aoki Y,Yamagata M,Nakajima F.Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion:a possible limitation of unilateral pedicle screw fixation[J].Neurosurg Spine,2010,13(3):381-387.
[15]王庆敏,陈鲁峰,曾蔚林,等.经MAST Quadrant通道下微创腰椎融合术近期疗效观察[J].临床骨科杂志,2011,6:605-608.
[16]Wang HL,LüFZ,Jiang JY,et al.Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery:a prospective randomized clinical trial[J].Chin Med J(Engl),2011,124(23):3868-3874.
[17]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,2014,2:121-126.
[2]Foley KT,Lefkowitz MA.Advances in minimally invasive spine surgery[J].Clin Neurosurg,2002,49:499-517.
[3]王强,吴寅良,朱和平.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.
[4]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.
[5]黄晓川,刘晖.微创通道椎间融合内固定术与开放椎间融合高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.
[6]Mc Cormack HM,del Horne DJ,Sheather S.Clinical applications of visual analogue scales:a critical review[J].Psychol Med,1998,18(4):1007-1019.
[7]Blume HG,Rojas CH.Unilateral lumbar interbody fusion(posterior approach)utilizing dowel graft[J].Neurol Orthop Surg,1981,2:171-175.
[8]成浩,徐建广.TLIF技术的临床应用与进展[J].中国矫形外科杂志,2008,20:1560-1601.
[9]Rouben D,Casnellie M,Ferguson M.Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion:a clinical and radiographic follow-up[J].Spinal Disord Tech,2011,24(5):288-296.
[10]Glassman SD,Copay AG,Berven SH,et al.Defining substantial clinical benefit following lumbar spine arthrodesis[J].J Bone Joint Surg Am,2008,90(9):1839-1847.
[11]邵诗泽,张恩忠,付松谭,等.腰骶段多裂肌的形态特点及功能意义[J].中国临床解剖学杂志,2010,1:17-19.
[12]陈国平,洪天禄,李淑葵,等.多裂肌间隙入路手术治疗腰椎手术失败综合征[J].实用骨科杂志,2013,4:289-293.
[13]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.
[14]Aoki Y,Yamagata M,Nakajima F.Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion:a possible limitation of unilateral pedicle screw fixation[J].Neurosurg Spine,2010,13(3):381-387.
[15]王庆敏,陈鲁峰,曾蔚林,等.经MAST Quadrant通道下微创腰椎融合术近期疗效观察[J].临床骨科杂志,2011,6:605-608.
[16]Wang HL,LüFZ,Jiang JY,et al.Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery:a prospective randomized clinical trial[J].Chin Med J(Engl),2011,124(23):3868-3874.
[17]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,2014,2:121-126.