双侧经微创通道腰椎体间融合术治疗复发性腰椎间盘突出症的疗效分析
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摘要
目的探讨双侧经微创通道腰椎体间融合术(TLIF)治疗复发性腰椎间盘突出症(RLDH)的疗效。方法方便收集2012年12月—2016年3月在该院住院治疗的RLDH合并腰椎不稳或滑脱患者31例,采用双侧椎旁肌间隙入路,在Quadrant通道下,微创TLIF治疗,观察患者术前、术后1周、术后12个月时的VAS评分及JOA评分变化和腰椎功能改善情况。结果术后1周、术后12个月时VAS、JOA评分评分[(2.50±0.98)分、(1.06±0.73)分]、[(16.58±2.19)分、(25.43±3.07)分],逐渐改善(t=21.456,4.863;t=6.561,13.067;P<0.05),尤其是术后12个月时疼痛、腰椎功能JOA评分显著改善。术后12个月时腰椎功能改善达优良率为93.5%。随访期间未发生椎弓根螺钉断裂、融合器移位等并发症。结论对RLDH已存在或潜在腰椎不稳或滑脱患者,采用双侧椎旁肌间隙入路,微创TLIF治疗,能减少术中出血,减轻患者痛苦,促进术后恢复,并发症少等优势,值得临床推广应用。
Objective To investigate the efficacy of bilateral minimally invasive lumbar interbody fusion(TLIF) in the treatment of recurrent lumbar disc herniation(RLDH). Methods Convenient select 31 patients with lumbar instability or spondylolisthesis who were hospitalized in our hospital from December 2012 to March 2016 were enrolled. The bilateral paravertebral muscle space approach was used. Mini-invasive TLIF treatment was observed under the Quadrant channel.VAS scores and JOA scores and lumbar spine function improvement before, 1 week, and 12 months after surgery. Results VAS and JOA scores were scored at 1 week and 12 months after surgery [(2.50±0.98)points,(1.06±0.73)points, [(16.58±2.19)points,(25.43±3.07)points], gradual improvement(t=21.456, 4.863; t=6.561, 13.067; P<0.05), especially at 12 months postoperatively, the JOA score of pain and lumbar function was significantly improved. Lumbar function improved to an excellent rate of 93.5% at 12 months after surgery. No complications such as pedicle screw fracture and cage displacement occurred during follow-up. Conclusion For patients with RLDH existing or potential lumbar instability or spondylolisthesis,bilateral paravertebral muscle approach, minimally invasive TLIF treatment can reduce intraoperative bleeding, reduce patient suffering, promote postoperative recovery, and have fewer complications, worthy of clinical application.
Objective To investigate the efficacy of bilateral minimally invasive lumbar interbody fusion(TLIF) in the treatment of recurrent lumbar disc herniation(RLDH). Methods Convenient select 31 patients with lumbar instability or spondylolisthesis who were hospitalized in our hospital from December 2012 to March 2016 were enrolled. The bilateral paravertebral muscle space approach was used. Mini-invasive TLIF treatment was observed under the Quadrant channel.VAS scores and JOA scores and lumbar spine function improvement before, 1 week, and 12 months after surgery. Results VAS and JOA scores were scored at 1 week and 12 months after surgery [(2.50±0.98)points,(1.06±0.73)points, [(16.58±2.19)points,(25.43±3.07)points], gradual improvement(t=21.456, 4.863; t=6.561, 13.067; P<0.05), especially at 12 months postoperatively, the JOA score of pain and lumbar function was significantly improved. Lumbar function improved to an excellent rate of 93.5% at 12 months after surgery. No complications such as pedicle screw fracture and cage displacement occurred during follow-up. Conclusion For patients with RLDH existing or potential lumbar instability or spondylolisthesis,bilateral paravertebral muscle approach, minimally invasive TLIF treatment can reduce intraoperative bleeding, reduce patient suffering, promote postoperative recovery, and have fewer complications, worthy of clinical application.
引文
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[12]许立臣,许卫兵,杨东方,等.俯卧位和侧卧位下经皮椎间孔镜摘除椎间盘治疗老年退行性腰椎间盘突出症:随机对照临床试验方案及预试验结果[J].中国组织工程研究,2018,5(5):756-757.
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[14]康金平,刘安平,周正新.经皮椎间孔镜治疗单节段腰椎间盘突出症32例临床体会[J].中医药临床杂志,2018(6):1141-1143.
[15]陈弘林,夏波,赵疆.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展[J].新疆中医药,2018(3):100-103.
[16]周炳康,郭庆功,杨广杰,等.单侧与双侧微创经椎间孔入路腰椎椎间融合手术治疗腰椎退行性疾病的比较[J].颈腰痛杂志,2017,38(5):435-438.
[2]徐峰,张同会,蔡贤华,等.经皮椎间孔镜治疗复发性腰椎间盘突出症的临床应用[J].中国矫形外科杂志,2016,24(13):1179-1183.
[3]姚海燕,张爱明,梁道臣,等.复发性腰椎间盘突出症主要影响因素探讨[J].深圳中西医结合杂志,2016,26(14):89-90.
[4]何文山,郭德全,韩东杰.复发性腰椎间盘突出症再手术的术式选择及疗效分析[J].世界最新医学信息文摘,2016,16(49):70,72.
[5]黄晓魏,颜志坚,麦伟,等.经Quadrant通道单侧椎弓根钉内固定及椎间融合治疗复发性腰椎间盘突出症[J].中国骨与关节损伤杂志,2016,31(9):970-971.
[6]吴辉,李伟,蒋婷,等.椎间孔入路微创手术与椎板开窗治疗复发性腰椎间盘突出症的效果比较[J].西部医学,2016,28(12):1680-1683,1689.
[7]李桂龙.复发性腰椎间盘突出症应用椎间孔镜治疗的效果研究[J].当代医学,2017,23(2):60-61.
[8]杨龙彪,高清元,赵东.复发性腰椎间盘突出症应用经皮内镜椎间孔入路微创治疗的疗效观察[J].贵州医药,2017,41(4):394-395.
[9]李永.经皮椎间孔镜与椎板开窗手术治疗复发性腰椎间盘突出症对比研究[J].河南外科学杂志,2017,23(4):115-116.
[10]胡小刚.经皮椎间孔镜与传统椎板开窗髓核摘除术在复发性腰椎间盘突出症的疗效对比分析[J].颈腰痛杂志,2017,38(6):564-567.
[11]任士海,王鹏,赵伟,等.单侧与双侧椎弓根内固定治疗复发性腰椎间盘突出疗效比较[J].临床骨科杂志,2015,18(5):560-564.
[12]许立臣,许卫兵,杨东方,等.俯卧位和侧卧位下经皮椎间孔镜摘除椎间盘治疗老年退行性腰椎间盘突出症:随机对照临床试验方案及预试验结果[J].中国组织工程研究,2018,5(5):756-757.
[13]张磊.椎间孔镜治疗老年腰椎管狭窄症患者的疗效观察[J].实用临床医药杂志,2018(13):93-94,97.
[14]康金平,刘安平,周正新.经皮椎间孔镜治疗单节段腰椎间盘突出症32例临床体会[J].中医药临床杂志,2018(6):1141-1143.
[15]陈弘林,夏波,赵疆.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展[J].新疆中医药,2018(3):100-103.
[16]周炳康,郭庆功,杨广杰,等.单侧与双侧微创经椎间孔入路腰椎椎间融合手术治疗腰椎退行性疾病的比较[J].颈腰痛杂志,2017,38(5):435-438.