微创可扩张通道下腰椎间盘摘除椎间植骨融合内固定的临床研究
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摘要
目的:探讨微创可扩张通道下腰椎间盘摘除植骨融合内固定的优势。方法 :对2010年1月至2016年3月收治的48例具有腰椎间盘摘除植骨融合内固定手术适应证患者的临床资料进行回顾性分析。48例患者采用单位组随机排列法随机分成可扩张通道下腰椎间盘摘除椎间植骨融合内固定组(通道组)和后路开放腰椎间盘摘除椎间植骨融合内固定组(传统组,包括后路椎间融合、经椎间孔椎体间融合等),其中通道组26例,男20例,女6例;年龄43~74岁,平均(56.6±5.1)岁;病程4~22个月,平均(6.7±1.8)个月;合并糖尿病1例,高血压病6例,心律不齐2例。传统组22例,男15例,女7例;年龄43~73岁,平均(55.9±4.6)岁;病程4~26个月,平均(6.2±2.1)个月;合并糖尿病2例,高血压病5例,心律不齐1例。观察两组手术时间、出血量、住院时间,比较两组术前及术后3、6个月的VAS评分、ODI评分及骨融合例数和切口相关并发症。结果:48例患者均获得6个月以上的随访。两组患者术后VAS评分和ODI评分均较术前有明显改善(P<0.01),术后3、6个月两组比较VAS评分差异无统计学意义,而ODI评分通道组低于传统组(P<0.01)。手术时间、出血量、住院时间在通道组分别为(167.3±30.2)min、(407.3±149.4)ml、(12.3±2.4)d,在传统手术组分别是(197.5±48.7)min、(786.8±147.8)ml、(16.5±3.8)d,两组差异有统计学意义(P<0.05)。两组病例椎体融合率和融合时间上差异无统计学意义。切口相关并发症通道组4例,较传统组的7例明显减少(P<0.01)。结论:微创可扩张通道下腰椎间盘摘除植骨融合内固定较传统手术创伤小、手术时间短、功能恢复好,对椎体融合无明显影响。
Objective:To explore the advantages of minimally invasive expandable in surgery of lumbar discectomy and interbody fusion and internal fixation. Methods:The clinical data of 48 patients who underwent lumbar discectomy and interbody fusion and internal fixation from January 2010 to March 2016 was retrospectively analyzed. According to the admission queue,the patients were randomly assigned into channel group(26 cases) or traditional group(22 cases). In channel group,surgical approach of minimally invasive expandable channel was applied,and in traditional group,open posterior operation approach(including posterior lumbar interbody fusion and transforaminal lumbar interbody fusion,etc.)was applied. In channel group,there were 20 males and 6 females,aged from 43 to 74 years with an average of(56.6 ±5.1)years;course of disease was ranged from 4 to 22 months with an average of(6.7 ±1.8) months;1 case was complicated with diabetes,6 cases were complicated with hypertensive disease,and 2 cases were complicated with arrhythmia. In traditional group,there were 15 males and 7 females,aged from 43 to 73 years with an average of(55.9±4.6) years;course of disease was ranged from 4 to 26 months with an average of(6.2 ±2.1) months;2 cases were complicated with diabetes,5 cases were complicated with hypertensive disease,and 1 case was complicated with arrhythmia. Operation time,bleeding volume,and hospitalization time were compared between two groups and visual analogue scale(VAS),Oswestry Disability Index(ODI),bone fusion information,and complications correlated with incision were observed in two groups. Results:All 48 patients were followed up for more than 6 months. Postoperative VAS and ODI were significantly improved(P<0.01),but 3 and 6 months after operation,there was no significant difference in VAS between two groups,and ODI score of channel group was lower than that of traditional group(P <0.01). Operation time,bleeding volume,hospitalization time in channel group respectively were(167.3±30.2) min,(786.8±147.8) ml,(12.3±2.4) d,and in traditional group were(197.5±48.7) min,(786.8±147.8) ml,(16.5±3.8) d,there was significant differences between two groups. There was no significant difference in fusion rate and fusion time between two groups. There were 4 cases and 7 cases developed incision related complications in channel group and traditional group,respectively. The difference between two groups was significant(P <0.01). Conclusion:Compared with conventional surgery mini mally invasive lumbar discectomy and in terbody fusion and internal fixation has advantages of less trauma,shorter operative time and better functional recovery.
Objective:To explore the advantages of minimally invasive expandable in surgery of lumbar discectomy and interbody fusion and internal fixation. Methods:The clinical data of 48 patients who underwent lumbar discectomy and interbody fusion and internal fixation from January 2010 to March 2016 was retrospectively analyzed. According to the admission queue,the patients were randomly assigned into channel group(26 cases) or traditional group(22 cases). In channel group,surgical approach of minimally invasive expandable channel was applied,and in traditional group,open posterior operation approach(including posterior lumbar interbody fusion and transforaminal lumbar interbody fusion,etc.)was applied. In channel group,there were 20 males and 6 females,aged from 43 to 74 years with an average of(56.6 ±5.1)years;course of disease was ranged from 4 to 22 months with an average of(6.7 ±1.8) months;1 case was complicated with diabetes,6 cases were complicated with hypertensive disease,and 2 cases were complicated with arrhythmia. In traditional group,there were 15 males and 7 females,aged from 43 to 73 years with an average of(55.9±4.6) years;course of disease was ranged from 4 to 26 months with an average of(6.2 ±2.1) months;2 cases were complicated with diabetes,5 cases were complicated with hypertensive disease,and 1 case was complicated with arrhythmia. Operation time,bleeding volume,and hospitalization time were compared between two groups and visual analogue scale(VAS),Oswestry Disability Index(ODI),bone fusion information,and complications correlated with incision were observed in two groups. Results:All 48 patients were followed up for more than 6 months. Postoperative VAS and ODI were significantly improved(P<0.01),but 3 and 6 months after operation,there was no significant difference in VAS between two groups,and ODI score of channel group was lower than that of traditional group(P <0.01). Operation time,bleeding volume,hospitalization time in channel group respectively were(167.3±30.2) min,(786.8±147.8) ml,(12.3±2.4) d,and in traditional group were(197.5±48.7) min,(786.8±147.8) ml,(16.5±3.8) d,there was significant differences between two groups. There was no significant difference in fusion rate and fusion time between two groups. There were 4 cases and 7 cases developed incision related complications in channel group and traditional group,respectively. The difference between two groups was significant(P <0.01). Conclusion:Compared with conventional surgery mini mally invasive lumbar discectomy and in terbody fusion and internal fixation has advantages of less trauma,shorter operative time and better functional recovery.
引文
[1]Brantigan JW,Steffee AD.A carbon fiber implant to aid interbody Lumber fusion.Two-year clinical results in the first 26 patients[J].Spine(Phila Pa1976),1993,18(14):2106-2117.
[2]胡志军,范顺武,赵兴.微创后路腰椎椎体间融合术椎旁软组织解剖与评估[J].国际骨科学杂志,2007,5:295-297.HU ZJ,FAN SW,ZHAO X.Minimally invasive posterior lumbar vertebral fusion between vertebral side soft tissue dissection and evaluation[J].Guo Ji Gu Ke Xue Za Zhi,2007,5:295-297.Chinese.
[3]Fukui M,Chiba K,Kawakami M.Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire(JOACMEQ):part 4.Establishment of equations for severity scores.Subcommittee on low back pain and cervical myelopathy,evaluation of the clinical outcome committee of the Japanese Orthopaedic Association[J].J Orthop Sci,2008,13(1):25-31.
[4]林斌,林秋燕,何明长,等.经Quadrant通道单侧椎弓根固定椎体间融合治疗腰椎退行性疾病[J].中国骨伤,2012,25(6):468-473.LIN B,LIN QY,HE MC,et al.Quadrant unilateral pedicle channels with fixed vertebral fusion between treatment of lumbar degenerative disease[J].Zhongguo Gu Shang/China J Orthop Trauma,2012,25(6):468-473.Chinese with abstract in English.
[5]文天林,刘秀梅,杜培,等.Quadrant微创通道下单侧开窗减压与开放减压内固定术治疗退变性腰椎管狭窄症病例对照研究[J].中国骨伤,2014,27(8):658-662.WEN TL,LIU XM,DU P,et al.Under the Quadrant minimally invasive channel unilateral windowing decompression with open decompression and internal fixation in the treatment of degenerative lumbar spinal stenosis disease case-control studies[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(8):658-662.Chinese with abstract in English.
[6]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,2014,24(2):121-126.WANG ZR,LU AQ,YANG HL,et al.Quadrant channel TLIF for the treatment of recurrent lumbar disc herniation:analysis of the efficacy[J].Zhongguo Ji Zhu Ji Sui Za Zhi,2014,24(2):121-126.Chinese.
[7]王建华,夏虹,李树林,等.微创经椎间孔腰椎椎间融合术的应用解剖学研究[J].中国脊柱脊髓杂志,2009,19(10):765-767.WANG JH,XIA H,LI SL,et al.Application of minimally invasive lumbar interbody fusion in lumbar interbody fusion[J].Zhongguo Ji Zhu Ji Sui Za Zhi,2009,19(10):765-767.Chinese.
[2]胡志军,范顺武,赵兴.微创后路腰椎椎体间融合术椎旁软组织解剖与评估[J].国际骨科学杂志,2007,5:295-297.HU ZJ,FAN SW,ZHAO X.Minimally invasive posterior lumbar vertebral fusion between vertebral side soft tissue dissection and evaluation[J].Guo Ji Gu Ke Xue Za Zhi,2007,5:295-297.Chinese.
[3]Fukui M,Chiba K,Kawakami M.Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire(JOACMEQ):part 4.Establishment of equations for severity scores.Subcommittee on low back pain and cervical myelopathy,evaluation of the clinical outcome committee of the Japanese Orthopaedic Association[J].J Orthop Sci,2008,13(1):25-31.
[4]林斌,林秋燕,何明长,等.经Quadrant通道单侧椎弓根固定椎体间融合治疗腰椎退行性疾病[J].中国骨伤,2012,25(6):468-473.LIN B,LIN QY,HE MC,et al.Quadrant unilateral pedicle channels with fixed vertebral fusion between treatment of lumbar degenerative disease[J].Zhongguo Gu Shang/China J Orthop Trauma,2012,25(6):468-473.Chinese with abstract in English.
[5]文天林,刘秀梅,杜培,等.Quadrant微创通道下单侧开窗减压与开放减压内固定术治疗退变性腰椎管狭窄症病例对照研究[J].中国骨伤,2014,27(8):658-662.WEN TL,LIU XM,DU P,et al.Under the Quadrant minimally invasive channel unilateral windowing decompression with open decompression and internal fixation in the treatment of degenerative lumbar spinal stenosis disease case-control studies[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(8):658-662.Chinese with abstract in English.
[6]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,2014,24(2):121-126.WANG ZR,LU AQ,YANG HL,et al.Quadrant channel TLIF for the treatment of recurrent lumbar disc herniation:analysis of the efficacy[J].Zhongguo Ji Zhu Ji Sui Za Zhi,2014,24(2):121-126.Chinese.
[7]王建华,夏虹,李树林,等.微创经椎间孔腰椎椎间融合术的应用解剖学研究[J].中国脊柱脊髓杂志,2009,19(10):765-767.WANG JH,XIA H,LI SL,et al.Application of minimally invasive lumbar interbody fusion in lumbar interbody fusion[J].Zhongguo Ji Zhu Ji Sui Za Zhi,2009,19(10):765-767.Chinese.