两种入路联合固定融合治疗腰椎退行性疾病的早期并发症分析
|
摘要
目的比较正中入路小切口与通道下经肌间隙入路联合固定并椎间融合治疗腰椎退行性疾病的早期并发症。方法采用传统正中入路小切口单侧椎弓根螺钉+瞄准器引导下对侧椎板关节突螺钉联合固定并椎间融合(小切口组)治疗166例腰椎退行性疾病患者,采用通道下经肌间隙入路下同样的联合固定融合技术(通道组)治疗112例腰椎退行性疾病患者。对两组早期并发症进行比较。结果小切口组和通道组并发症病例数分别为22例(13. 25%)、37例(33. 04%),差异有统计学意义(P <0. 01);在发生任意并发症、仅发生次要并发症、切口愈合问题及其他并发症4项中,通道组发生率均高于小切口组(P <0. 05)。结论应用单侧椎弓根螺钉+经皮对侧椎板关节突螺钉联合固定并椎间融合术治疗腰椎退行性疾病,术后早期并发症发生率通道组明显高于小切口组,主要发生神经损伤及切口皮肤问题。通道下手术存在明显的学习曲线,应选择合适病例,严谨操作。
Objective To compare the perioperative complications associated with a combined fixation and interbody fusion for treating lower lumbar degenerative diseases(LLDD) via the median approach or minimally invasive approach. Methods The 166 patients with LLDD underwent unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion via median approach(small incision group); 112 patients with LLDD underwent the same fixation and lumbar interbody fusion by minimally invasive approach(MI approach group). The perioperative complications of the two groups were compared. Results In the small incision group,perioperative complications occurred in 22 cases(13. 25%),compared with 37 cases(33. 04%)in the MI approach group,there was statistical difference(P < 0. 01). In the items of had any complication,only had minor complication,had incision problem and had other complications,MI approach group had higher incidence rate than small incision group(P < 0. 05). Conclusions The incidence rate of perioperative complications is obviously higher in the MI approach group than in the small incision group,using the combined fixation and interbody fusion to treat LLDD,especially in the complications of nerve injury and problems of incision. The MI approach surgery has steep learning curve,surgeons should choose appropriate cases and operate cautiously.
Objective To compare the perioperative complications associated with a combined fixation and interbody fusion for treating lower lumbar degenerative diseases(LLDD) via the median approach or minimally invasive approach. Methods The 166 patients with LLDD underwent unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion via median approach(small incision group); 112 patients with LLDD underwent the same fixation and lumbar interbody fusion by minimally invasive approach(MI approach group). The perioperative complications of the two groups were compared. Results In the small incision group,perioperative complications occurred in 22 cases(13. 25%),compared with 37 cases(33. 04%)in the MI approach group,there was statistical difference(P < 0. 01). In the items of had any complication,only had minor complication,had incision problem and had other complications,MI approach group had higher incidence rate than small incision group(P < 0. 05). Conclusions The incidence rate of perioperative complications is obviously higher in the MI approach group than in the small incision group,using the combined fixation and interbody fusion to treat LLDD,especially in the complications of nerve injury and problems of incision. The MI approach surgery has steep learning curve,surgeons should choose appropriate cases and operate cautiously.
引文
[1] Sethi A,Lee S,Vaidya R. Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw[J]. Eur Spine,2009,18(3):430-434.
[2]曾忠友,严卫锋,陈国军,等.单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合治疗下腰椎病变的临床观察[J].中华骨科杂志,2011,31(8):834-839.
[3]毛克亚,王岩,肖嵩华,等.单侧微创经椎间孔腰椎体间融合术采用椎弓根螺钉结合经椎板关节突螺钉混合内固定可行性研究[J].中华外科杂志,2011,49(12):1067-1070.
[4]曾忠友,吴鹏,宋永兴,等.小切口单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定并椎间融合治疗腰椎病变的并发症分析[J].中国骨伤,2016,29(3):34-43.
[5]曾忠友,江春宇,宋永兴,等.下腰椎椎板、关节突的影像学测量与临床意义[J].中国临床解剖学杂志,2009,27(4):420-422,425.
[6]曾忠友,江春宇,张建乔,等.腰椎椎板关节突螺钉瞄准器的研制[J].中国骨与关节损伤杂志,2009,24(4):761-762.
[7] Xu R,Ebraheim N A,Ou Y,et al. Anatomy considerations of pedicle screw placement in the thoracis spine:Roy-Camille technique versus open-lamina technique[J]. Spine,1998,23(9):1065-1068.
[8] Uribe J S,Deukmedjian A R,Mummaneni P V,et al. Complications in adult spinal deformity surgery:an analysis of minimally invasive,hybrid,and open surgical techniques[J]. Neurosurg Focus,2014,36(5):E15.
[9] Sethi A,Muzumdar A M,Ingalhalikar A,et al. Biomechanical analysis of a novel posterior construct in a transforaminal lumbar interbody fusion model an in vitro study[J]. Spine,2011,11(9):863-869.
[10] Awad B I,Lubelski D,Shin J H,et al. Bilateral pedicle screw fixation versus unilateral pedicle and contralateral facet screws for minimally invasive transforaminal lumbar interbody fusion:clinical uutcomes and cost analysis[J]. Global Spine,2013,3(4):225-230.
[11] Sclafani J A,Kim C W. Complications associated with the initial learning curve of minimally invasive spine surgery:a systematic review[J]. Clin Orthop Relat Res,2014,472(6):1711-1717.
[12] Silva P S,Pereira P,Monteiro P,et al. Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion[J]. Neurosurg Focus,2013,35(2):E7.
[13] Lee K H,Yeo W,Soeharno H,et al. Learning curve of a complex surgical technique:minimally invasive transforaminal lumbar interbody fusion(MIS TLIF)[J]. J Spinal Disord Tech,2014,27(7):234-240.
[14] Isley M R,Zhang X F,Balzer J R,et al. Current trends in pedicle screw stimulation techniques:lumbosacral,thoracic,and cervical levels[J]. Neurodiagn,2012,52(2):100-175.
[15] Jurícek M,Rehák L,TisovskP,et al. The effect of complications on the quality of life after surgery for lumbar spine degenerative disease[J]. Acta Chir Orthop Traumatol Cech,2010,77(2):112-117.
[16] Gautschi O P,Schatlo B,Schaller K,et al. Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management:a literature review of 35,630 pedicle screws[J]. Neurosurg Focus,2011,31(4):E8.
[17] Audat Z M,Darwish F T,Al Barbarawi M M,et al. Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction[J]. Scoliosis,2011,6(1):14.
[18] Amiri A R,Fouyas I P,Cro S,et al. Postoperative spinal epidural hematoma(SEH):incidence,risk factors,onset,and management[J]. Spine,2013,13(2):134-140.
[19]孙常太.手术小型化微创化是治疗腰椎退行性疾病的理想追求[J].中国骨伤,2012,6(25):445-447.
[2]曾忠友,严卫锋,陈国军,等.单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合治疗下腰椎病变的临床观察[J].中华骨科杂志,2011,31(8):834-839.
[3]毛克亚,王岩,肖嵩华,等.单侧微创经椎间孔腰椎体间融合术采用椎弓根螺钉结合经椎板关节突螺钉混合内固定可行性研究[J].中华外科杂志,2011,49(12):1067-1070.
[4]曾忠友,吴鹏,宋永兴,等.小切口单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定并椎间融合治疗腰椎病变的并发症分析[J].中国骨伤,2016,29(3):34-43.
[5]曾忠友,江春宇,宋永兴,等.下腰椎椎板、关节突的影像学测量与临床意义[J].中国临床解剖学杂志,2009,27(4):420-422,425.
[6]曾忠友,江春宇,张建乔,等.腰椎椎板关节突螺钉瞄准器的研制[J].中国骨与关节损伤杂志,2009,24(4):761-762.
[7] Xu R,Ebraheim N A,Ou Y,et al. Anatomy considerations of pedicle screw placement in the thoracis spine:Roy-Camille technique versus open-lamina technique[J]. Spine,1998,23(9):1065-1068.
[8] Uribe J S,Deukmedjian A R,Mummaneni P V,et al. Complications in adult spinal deformity surgery:an analysis of minimally invasive,hybrid,and open surgical techniques[J]. Neurosurg Focus,2014,36(5):E15.
[9] Sethi A,Muzumdar A M,Ingalhalikar A,et al. Biomechanical analysis of a novel posterior construct in a transforaminal lumbar interbody fusion model an in vitro study[J]. Spine,2011,11(9):863-869.
[10] Awad B I,Lubelski D,Shin J H,et al. Bilateral pedicle screw fixation versus unilateral pedicle and contralateral facet screws for minimally invasive transforaminal lumbar interbody fusion:clinical uutcomes and cost analysis[J]. Global Spine,2013,3(4):225-230.
[11] Sclafani J A,Kim C W. Complications associated with the initial learning curve of minimally invasive spine surgery:a systematic review[J]. Clin Orthop Relat Res,2014,472(6):1711-1717.
[12] Silva P S,Pereira P,Monteiro P,et al. Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion[J]. Neurosurg Focus,2013,35(2):E7.
[13] Lee K H,Yeo W,Soeharno H,et al. Learning curve of a complex surgical technique:minimally invasive transforaminal lumbar interbody fusion(MIS TLIF)[J]. J Spinal Disord Tech,2014,27(7):234-240.
[14] Isley M R,Zhang X F,Balzer J R,et al. Current trends in pedicle screw stimulation techniques:lumbosacral,thoracic,and cervical levels[J]. Neurodiagn,2012,52(2):100-175.
[15] Jurícek M,Rehák L,TisovskP,et al. The effect of complications on the quality of life after surgery for lumbar spine degenerative disease[J]. Acta Chir Orthop Traumatol Cech,2010,77(2):112-117.
[16] Gautschi O P,Schatlo B,Schaller K,et al. Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management:a literature review of 35,630 pedicle screws[J]. Neurosurg Focus,2011,31(4):E8.
[17] Audat Z M,Darwish F T,Al Barbarawi M M,et al. Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction[J]. Scoliosis,2011,6(1):14.
[18] Amiri A R,Fouyas I P,Cro S,et al. Postoperative spinal epidural hematoma(SEH):incidence,risk factors,onset,and management[J]. Spine,2013,13(2):134-140.
[19]孙常太.手术小型化微创化是治疗腰椎退行性疾病的理想追求[J].中国骨伤,2012,6(25):445-447.