Wiltse入路改良TLIF治疗伴有钙化或骨化的高位腰椎间盘突出症
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摘要
目的探讨Wiltse入路改良经椎间孔腰椎间融合术(TLIF)治疗伴有钙化或骨化的高位腰椎间盘突出症的近期临床疗效及安全性。方法选择44例符合标准的伴有钙化或骨化的高位腰椎间盘突出症患者,根据治疗方法不同分为观察组(采用Wiltse入路改良TLIF,21例)和对照组(采用传统后正中入路TLIF,23例)。比较两组的手术情况、术后并发症、疼痛VAS评分、ODI、JOA评分。结果术中出血量、术后引流量、术后下地时间、术后住院时间观察组均明显少于对照组(P <0. 05);手术时间观察组长于对照组(P <0. 05)。患者均获得随访,时间8～15个月。术后1周、3个月,VAS评分、ODI、JOA评分观察组均明显优于对照组(P <0. 05)。术后6个月,VAS评分观察组优于对照组(P <0. 05),ODI及JOA评分两组比较差异均无统计学意义(P> 0. 05)。术后脑脊液漏、神经损伤或激惹发生率两组比较差异有统计学意义(P <0. 05),切口和硬脊膜撕裂发生率两组比较差异均无统计学意义(P> 0. 05)。结论 Wiltse入路改良TLIF治疗伴有钙化或骨化的高位腰椎间盘突出症可获得良好的疗效。
Objective To investigate the clinical efficacy and safety of the modified transforaminal lumbar interbody fusion( TLIF) in the treatment of upper lumbar disc herniation with calcification or ossification via Wiltse approach.Methods A total of 44 patients with calcified or ossified upper lumbar disc herniation were selected and divided into the observation group( modified TLIF via Wiltse approach,21 cases) and the control group( TLIF via traditional posterior median approach,23 cases). The operation conditions,postoperative complications,pain VAS,ODI,and JOA score were compared between the two groups. Results In the observation group,the intraoperative blood loss,postoperative drainage,postoperative down time,and postoperative hospitalization time were all significantly less than those in the control group( P < 0. 05); the operation time of the observation group was longer than that of the control group( P < 0. 05). All patients were followed up for 8 ～ 15 months. At 1 week and 3 months after surgery,the VAS,ODI,and JOA score in the observation group were significantly better than those in the control group( P < 0. 05). At6 months after surgery,VAS in the observation group were significantly lower than those in the control group( P <0. 05),there was no significant difference in ODI and JOA score between the two groups( P > 0. 05). There were significant differences between the two groups in the complications of cerebrospinal fluid leakage and nerve injury( P < 0. 05). No significant differences in the incidence of complications of incision and dural tear between the two groups were observed( P > 0. 05). Conclusions The modified TLIF with Wiltse approach in the treatment of upper lumbar disc herniation with calcification or ossification can get a good effect.
Objective To investigate the clinical efficacy and safety of the modified transforaminal lumbar interbody fusion( TLIF) in the treatment of upper lumbar disc herniation with calcification or ossification via Wiltse approach.Methods A total of 44 patients with calcified or ossified upper lumbar disc herniation were selected and divided into the observation group( modified TLIF via Wiltse approach,21 cases) and the control group( TLIF via traditional posterior median approach,23 cases). The operation conditions,postoperative complications,pain VAS,ODI,and JOA score were compared between the two groups. Results In the observation group,the intraoperative blood loss,postoperative drainage,postoperative down time,and postoperative hospitalization time were all significantly less than those in the control group( P < 0. 05); the operation time of the observation group was longer than that of the control group( P < 0. 05). All patients were followed up for 8 ～ 15 months. At 1 week and 3 months after surgery,the VAS,ODI,and JOA score in the observation group were significantly better than those in the control group( P < 0. 05). At6 months after surgery,VAS in the observation group were significantly lower than those in the control group( P <0. 05),there was no significant difference in ODI and JOA score between the two groups( P > 0. 05). There were significant differences between the two groups in the complications of cerebrospinal fluid leakage and nerve injury( P < 0. 05). No significant differences in the incidence of complications of incision and dural tear between the two groups were observed( P > 0. 05). Conclusions The modified TLIF with Wiltse approach in the treatment of upper lumbar disc herniation with calcification or ossification can get a good effect.
引文
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[8] Wu J,Zhang C,Zheng W,et al. Analysis of the characteristics and clinical outcomes of percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation[J]. World Neurosurg,2016,92(8):142-147.
[9] Preda C,Sewell M D,Purushothaman B,et al. Foraminal decompression of acute calcified disc herniation in an adult[J]. Spine J,2015,15(6):1497-1498.
[10] Miyagi M,Ikeda O,Ohtori S,et al. Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF[J]. Eur Spine J,2013,22(8):1877-1883.
[11] Kunze B,Drasseck T,Kluba T. Posterior and transforaminal lumbar interbody fusion(PLIF/TLIF)for the treatment of localised segment degeneration of lumbar spine[J]. Z Orthop Unfall,2011,149(3):312-316.
[12] Cawley D T,Alexander M,Morris S. Multifidus innervation and muscle assessment post-spinal surgery[J]. Eur Spine J,2014,23(2):320-327.
[2]魏振,夏青,江海良,等.改良经椎间孔椎体间融合术治疗高位腰椎间盘突出症[J].中国骨伤,2010,23(4):308-310.
[3]郭晓辉,刘兰泽,栾媛媛,等.改良TLIF技术在高位腰椎间盘突出症治疗中的应用[J].实用骨科杂志,2015,21(5):394-396.
[4]梁成民,崔西龙,于海洋,等.高位腰椎间盘突出症的解剖学特点及术式选择[J].中国骨伤,2016,29(7):640-644.
[5]李松凯,倪斌,蓝旭,等.经椎间孔椎体间融合术治疗高位腰椎间盘突出症[J].临床骨科杂志,2014,17(1):20-22.
[6] Xu D,Chen Z,Zhao Y,et al. The clinical results of percutaneous endoscopic interlaminar discectomy(PEID)in the treatment of calcified lumbar disc herniation:A case-control study[J]. Pain Physician,2016,19(2):69-76.
[7]邓中博,何丁文,陈伟才,等.经皮椎板间入路内镜治疗钙化型腰椎间盘突出症[J].中国矫形外科杂志,2016,24(11):1045-1047.
[8] Wu J,Zhang C,Zheng W,et al. Analysis of the characteristics and clinical outcomes of percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation[J]. World Neurosurg,2016,92(8):142-147.
[9] Preda C,Sewell M D,Purushothaman B,et al. Foraminal decompression of acute calcified disc herniation in an adult[J]. Spine J,2015,15(6):1497-1498.
[10] Miyagi M,Ikeda O,Ohtori S,et al. Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF[J]. Eur Spine J,2013,22(8):1877-1883.
[11] Kunze B,Drasseck T,Kluba T. Posterior and transforaminal lumbar interbody fusion(PLIF/TLIF)for the treatment of localised segment degeneration of lumbar spine[J]. Z Orthop Unfall,2011,149(3):312-316.
[12] Cawley D T,Alexander M,Morris S. Multifidus innervation and muscle assessment post-spinal surgery[J]. Eur Spine J,2014,23(2):320-327.