MIS-TLIF治疗腰椎间盘突出症伴腰椎不稳早期临床疗效观察
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国家自然科学基金青年基金(81100929)


Clinical observation of early efficacy of MISTLIF in the treatment of lumbar disc herniation combined with lumbar instability
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    摘要:

    【摘要】 目的 探讨微创经椎间孔腰椎间融合术(MISTLIF)治疗腰椎间盘突出症伴腰椎不稳的早期临床疗,为临床手术治疗方案选择提供理论与实践依据。方法 回顾性研究分析2014年6月~2016年12月收治的符合选择标准的腰椎间盘突出症伴腰椎不稳患者44例,根据治疗方法不同分为 MISTLIF 组(21例)和开放TLIF组(23例)。比较分析两组患者的手术时间、术中出血量、术后引流量、切口长度、术后下地时间、术后住院时间、术后并发症及患者术前、术后不同时间点的疼痛视觉模拟量表评分(VAS)、Oswestry功能障碍指数(ODI)评分、日本骨科学会(JOA)评分情况。结果 MISTLIF组术中出血量、术后引流量、切口长度、术后下地时间、术后住院时间及术后3天VAS评分、ODI评分和JOA评分均优于开放TLIF组(P<005),两组手术时间比较差异无统计学意义 (P>005)。术后3月MISTLIF组的VAS评分优于开放TLIF组(P<005),其ODI、JOA评分及术后6月时两组VAS、ODI及JOA评分比较差异均无统计学意义(P>005)。开放TLIF组1例出现硬脊膜撕裂伴术后脑脊液漏,1例术后出现切口愈合不良,MISTLIF组1例出现硬脊膜撕裂,术后无脑脊液漏,1例术后出现背根神经节激惹症状;两组均无神经损伤、椎间隙感染、椎弓根钉断裂、松动、植骨移位等严重并发症发生,两组并发症发生率比较差异无统计学意义 (P>005)。结论 MISTLIF在治疗腰椎间盘突出症合并腰椎不稳上可获得与开放TLIF相同的疗效,且该术式具有手术创伤小、出血少、术后恢复快等优点,是一种安全有效的手术方式,但中远期疗效和并发症情况需进一步观察。

    Abstract:

    【Abstract】 Objective To investigate the early effectiveness and safety of minimally invasive transforaminal lumbar interbody fusion (MISTLIF) in the treatment of lumbar disc herniation combined with lumbar instability and improve the theoretical and practical basis for the choice of clinical surgical treatment options. Methods Between June 2014 and December 2016, 44 patients with singlelevel lumbar disc herniation accompanied by lumbar instability underwent MISTLIF (MISTLIF group, 21 cases) and openTLIF in (openTLIF group, 23 cases). The clinical data were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative drainage volume, length of incision, postoperative down time, postoperative hospitalization time, and postoperative complications, visual analogue scale (VAS) before and after the surgery,as well as Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) were compared for the patients in two groups. Results The intraoperative blood loss, postoperative drainage volume, length of incision, postoperative down time, postoperative hospitalization time, and VAS, ODI, and JOA scores at day 3 after surgery of MISTLIF group were obviously better than that of open TLIF group in (P<005). No difference was found in operation time between the 2 groups (P>005). The VAS score in the MISTLIF group at month 3 was better than that in the open TLIF group (P<005), and no significant differences were found in the ODI and JOA scores at this time point after surgery (P>005). At sixth months after operation, there were no significant differences in VAS, ODI and JOA scores between the two groups (P>005). In the open TLIF group, there was 1 case of dural tear associated with postoperative cerebrospinal fluid leakage, and 1 case had poor healing of the incision. There was 1 case of dura mater laceration in the MISTLIF group, no cerebrospinal fluid leakage, and 1 case of root ganglion irritation after operation. There were no severe complications, such as neurological injuries, intervertebral space infection, pedicle screw breakage, loosening, and displacement of bone graft. There was no significant difference between the two groups in the complication rate (P>005). Conclusion Through the study on the early clinical effects, MISTLIF, which is characterized by minimal invasion, less blood loss, and quick recovery after operation, may receive the same curative effect as the traditional open TLIF in treating the lumbar disc herniation combined with lumbar instability, and it is a safe and effective surgical procedure.

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  • 在线发布日期: 2018-08-01
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