微创经椎间孔腰椎椎体间融合术治疗下腰椎疾病

Preliminary report of minimally invasive transformainal lumbar interbody fusion assisted by X- Tube system in the treatment of low back disorders

目的探讨扩张通道管系统（X-Tube）辅助下微创经椎间孔腰椎椎体间融合术（transforam—inallumbarinterbodyfusion，TLIF）治疗下腰椎疾患的临床价值。方法应用X—Tube辅助下微创TLIF治疗下腰椎病变患者25例，男16例，女9例；年龄34-65岁，平均52．4岁；单侧椎间盘突出伴椎间隙狭窄10例，椎间盘源性腰痛6例，单侧椎体后缘离断6例，脊柱不稳引起的力学源性腰腿痛1例，单侧侧隐窝狭窄2例。L3-4病变1例，L4-5病变14例，L3S1病变10例。患者术前、术后第l天及术后7天检查生化全套，测定肌酸激酶水平变化。随机统计另25例行开放TUF患者的肌酸激酶水平，并与行微创TLIF患者进行比较。结果25例行微创TLIF患者手术时间平均154min；术中出血平均367ml。微创TLIF术后第1天肌酸激酶水平明显低于开放手术（P〈0．001）。术后1例患者减压侧手术切口周缘皮肤坏死，经切除坏死皮肤，重新缝合切口后愈合，其余患者切口均一期愈合。25例行微创TLIF患者均获随访，随访时间6-15个月，平均10．7个月，除1例患者主诉手术区域轻度疼痛外，其余患者均未诉疼痛。Os—westry功能障碍评分由术前平均（34．6±6．1）分降至术后平均（15．6±5．4）分，手术结果优良。结论X—Tube辅助下微创TLIF治疗下腰椎疾患具有术中出血量少、创伤小、术后恢复快、短期疗效确切等优点。

Objective To evaluate the clinical outcomes of minimally invasive transformainal lumbar interbody fusion （TLIF） assisted by X-Tube system for the management of degenerative lumbar disease. Methods A total of 25 patients, 16 males and 9 females, with ages from 34 to 65 （average 52.4 years）, underwent rnlnirnally invasive TLIF assisted by the X-Tube system. The index diagnosis was interveterbral space stenosis with unilateral herniated nucleus pulposus in 10 cases, discogenic low back pain in 6 cases, separation of the posterior ring apophysis in 6 cases, mechanical low back pain in 1 case, foraminal stenosis of the lumbar spine in 2 cases. The changes of postoperative serum level of creatine kinase was estimated and compared with control group. Results Operative time was 125-200 min, and mean duration was 154 min. Blood loss was 250-620 ml, mean loss was 367 ml. The index of postoperative serum level of creatine kinase was lower obviously in rninirnally invasive TLIF than the open group. One case suffered the necrosis of incision margin but healed finally. All 25 patients were followed up. The period of follow-up was 6-15 months, the mean was 10.7 months. All patients didn＇t complain of pain in operative region except one case. The preoperative back pain and sciatica disappeared. Functional outcomes were quantified using the Oswestry Disability Index. The average Oswestry scores decreased from （34.6±6.1） preoperatively to （15.6±5.4） postoperatively. The outcomes of operation was satisfactory. Conclusion Minimally invasive TLIF assisted by X-TUbe system can minimize blood loss and tissue trauma, shorten the operative and recovery time, the short-term outcomes is excellent.