XLIF联合病灶清除内固定治疗单节段腰椎结核
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摘要
目的探讨极外侧椎间融合(XLIF)联合病灶清除内固定治疗单节段腰椎结核的初步临床效果。方法回顾性分析2013年1月至2014年5月广西贵港市人民医院收治的9例单节段腰椎结核患者的临床资料,其中3例L1/2椎体结核、2例L2/3椎体结核、4例L3/4椎体结核,均在微创通道下行XLIF联合病灶清除内固定治疗。记录手术时间和术中出血量,评估患者手术前后视觉模拟量表(VAS)、日本骨科学会(JOA)评分,观察术后并发症及植骨融合情况。结果所有患者均手术顺利,手术时间(70±22)min,术中出血量(110±32)m L,植骨融合时间(7.0±1.3)个月。术后随访6~13个月(平均9.6个月)。末次随访VAS、JOA评分均较术前明显改善,差异有统计学意义(P<0.05);末次随访JOA评分改善率为56%。2例患者术后出现左大腿前内侧皮肤感觉障碍及髂腰肌肌力下降,对症处理后3个月内恢复;随访期间影像学检查显示内固定位置良好,未出现植骨块吸收和骨不连,无结核复发病例。结论应用XLIF联合病灶清除内固定治疗单节段腰椎结核,具有手术创伤小、并发症少、术后恢复快、可早期下床活动、明显缓解疼痛症状和改善腰椎功能等优点。
Objective To investigate the preliminary clinical effect of extreme lateral interbody fusion(XLIF), debridement and internal fixation for treatment of single-segment lumbar spinal tuberculosis. Methods From January 2013 to May 2014, 9 patients with single-segment lumbar spinal tuberculosis including 3 patients involved in L_(1/2), 2 in L_(2/3) and 4 in L_(3/4), were treated by combination of XLIF, debridement and internal fixation under minimally invasive channel in Guigang People's Hospital, and their clinical data were analyzed retrospectively. Operation time and intraoperative estimate blood loss were recorded, visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA) scores were evaluated at preoperation and postoperation,postoperative complications and bony fusion were also observed. Results Operations were completed smoothly inall patients. The average operation time was(70 ± 22) min, intraoperative estimate blood loss was(110 ± 32)m L, bony fusion time was(7.0 ± 1.3) months. Patients were followed up for 6 to 13 months(average, 9.6months). VAS and JOA scores at the latest follow-up were improved compared with preoperative ones, the difference had statistical significance(P <0.05); The improvement rate of JOA score was 56% at the last follow-up. Sensory disorder in anteriomedial skin of left thigh and iliopsoas muscle weakness occurred in 2cases, and then recovered within 3 months after symptomatic treatment. Radiological examination during the follow-up showed that the fixation position was good, and there were no absorption of bone graft, bone nonunion or tuberculosis recurrence occurred. Conclusion Treatment of single-segment lumbar spinal tuberculosis by combination of XLIF, debridement and internal fixation, could relieve the symptom of pain and improve the function of lumbar vertebrae, with minimal trauma, less complications, rapid postoperative recovery and early ambulatory rehabilitation.
Objective To investigate the preliminary clinical effect of extreme lateral interbody fusion(XLIF), debridement and internal fixation for treatment of single-segment lumbar spinal tuberculosis. Methods From January 2013 to May 2014, 9 patients with single-segment lumbar spinal tuberculosis including 3 patients involved in L_(1/2), 2 in L_(2/3) and 4 in L_(3/4), were treated by combination of XLIF, debridement and internal fixation under minimally invasive channel in Guigang People's Hospital, and their clinical data were analyzed retrospectively. Operation time and intraoperative estimate blood loss were recorded, visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA) scores were evaluated at preoperation and postoperation,postoperative complications and bony fusion were also observed. Results Operations were completed smoothly inall patients. The average operation time was(70 ± 22) min, intraoperative estimate blood loss was(110 ± 32)m L, bony fusion time was(7.0 ± 1.3) months. Patients were followed up for 6 to 13 months(average, 9.6months). VAS and JOA scores at the latest follow-up were improved compared with preoperative ones, the difference had statistical significance(P <0.05); The improvement rate of JOA score was 56% at the last follow-up. Sensory disorder in anteriomedial skin of left thigh and iliopsoas muscle weakness occurred in 2cases, and then recovered within 3 months after symptomatic treatment. Radiological examination during the follow-up showed that the fixation position was good, and there were no absorption of bone graft, bone nonunion or tuberculosis recurrence occurred. Conclusion Treatment of single-segment lumbar spinal tuberculosis by combination of XLIF, debridement and internal fixation, could relieve the symptom of pain and improve the function of lumbar vertebrae, with minimal trauma, less complications, rapid postoperative recovery and early ambulatory rehabilitation.
引文
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[8]Marchi L,Oliveira L,Amaral R,et al.Lateral interbody fusion for treatment of discogenic low back pain:minimally invasive surgical techniques[J].Adv Orthop,2012:282068.
[9]Dakwar E,Cardona RF,Smith DA,et al.Early outcomes and safety of the minimally invasive,lateral retroperitoneal transpsoas approach for adult degenerative scoliosis[J].Neurosurg Focus,2010,28(3):E8.
[10]Costanzo G,Zoccali C,Maykowski P,et al.The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity[J].Eur Spine J,2014,23(Suppl 6):699-704.
[11]Quante M,Halm H.Extreme lateral interbody fusion:indication,surgical technique,outcomes and specific complication[J].Orthopade,2015,44(2):138-145.
[12]Youssef JA,Mc Afee PC,Patty CA,et al.Minimally invasive surgery:lateral approach interbody fusion:results and review[J].Spine,2010,35(26 Suppl):S302-S311.
[13]Cummock MD,Vanni S,Levi AD,et al.An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion[J].J Neurosurg Spine,2011,15(1):11-18.
[14]Santillan A,Patsalides A,Gobin YP.Endovascular embolization of iatrogenic lumbar artery pseudoaneurysm following extreme lateral interbody fusion(XLIF)[J].Vasc Endovascular Surg,2010,44(7):601-603.
[15]Tohmeh AG,Rodgers WB,Peterson MD.Dynamically evoked,discrete-threshold electromyography in the extreme lateral interbody fusion approach[J].J Neurosurg Spine,2011,14(1):31-37.
[16]洪乐鹏,廖丙修,罗嘉伦,等.XLIF入路相关的生殖股神经应用解剖及影像学研究[J].中国临床解剖学杂志,2015,33(6):617-622.
[17]谭海涛,江建中,谢兆林,等.肌电图监测在极外侧入路椎间融合术联合经皮椎弓根螺钉内固定术中的应用[J].中国脊柱脊髓杂志,2015,25(7):618-624.
[18]Berjano P,Lamartina C.Far lateral approaches(XLIF)in adult scoliosis[J].Eur Spine J,2013,22(Suppl 2):S242-S253.
[2]Erdo?an E,Erdog?n E.Classification of functional orthopaedic appliances in our opinions[J].Turk Orthodonti Derg,1989,2(1):47-50.
[3]丁江平,翁习生,王斌,等.经脊柱前路病灶清除植骨一期前路内固定术治疗脊柱结核[J].中华骨科杂志,2007,27(1):54-58.
[4]Scott J,Huskissson EC.Graphic representation of pain[J].Pain,1976,2(2):175-184.
[5]Shirado O,Doi T,Akai M,et al.An outcome measure for Japanese people with chronic low back pain:an introduction and validation study of Japan low back pain evaluation questionnaire[J].Spine,2007,32(26):3052-3059.
[6]许建中.对脊柱结核手术指征和手术方式的再认识[J].中国脊柱脊髓杂志,2006,16(12):889-890.
[7]唐勇,沈慧勇,高粱斌,等.腹膜后入路腹腔镜下手术治疗腰椎结核[J].中国脊柱脊髓杂志,2012,22(9):775-778.
[8]Marchi L,Oliveira L,Amaral R,et al.Lateral interbody fusion for treatment of discogenic low back pain:minimally invasive surgical techniques[J].Adv Orthop,2012:282068.
[9]Dakwar E,Cardona RF,Smith DA,et al.Early outcomes and safety of the minimally invasive,lateral retroperitoneal transpsoas approach for adult degenerative scoliosis[J].Neurosurg Focus,2010,28(3):E8.
[10]Costanzo G,Zoccali C,Maykowski P,et al.The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity[J].Eur Spine J,2014,23(Suppl 6):699-704.
[11]Quante M,Halm H.Extreme lateral interbody fusion:indication,surgical technique,outcomes and specific complication[J].Orthopade,2015,44(2):138-145.
[12]Youssef JA,Mc Afee PC,Patty CA,et al.Minimally invasive surgery:lateral approach interbody fusion:results and review[J].Spine,2010,35(26 Suppl):S302-S311.
[13]Cummock MD,Vanni S,Levi AD,et al.An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion[J].J Neurosurg Spine,2011,15(1):11-18.
[14]Santillan A,Patsalides A,Gobin YP.Endovascular embolization of iatrogenic lumbar artery pseudoaneurysm following extreme lateral interbody fusion(XLIF)[J].Vasc Endovascular Surg,2010,44(7):601-603.
[15]Tohmeh AG,Rodgers WB,Peterson MD.Dynamically evoked,discrete-threshold electromyography in the extreme lateral interbody fusion approach[J].J Neurosurg Spine,2011,14(1):31-37.
[16]洪乐鹏,廖丙修,罗嘉伦,等.XLIF入路相关的生殖股神经应用解剖及影像学研究[J].中国临床解剖学杂志,2015,33(6):617-622.
[17]谭海涛,江建中,谢兆林,等.肌电图监测在极外侧入路椎间融合术联合经皮椎弓根螺钉内固定术中的应用[J].中国脊柱脊髓杂志,2015,25(7):618-624.
[18]Berjano P,Lamartina C.Far lateral approaches(XLIF)in adult scoliosis[J].Eur Spine J,2013,22(Suppl 2):S242-S253.