微创经椎间孔腰椎椎间融合术翻修治疗腰椎退变性疾病

Minimally invasive transforaminal lumbar interbody fusion as revision surgery for lumbar degenerative diseases

目的回顾性分析微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MiTLIF)翻修治疗腰椎退变性疾病的临床结果和并发症。方法 2006年3月～2010年11月,对103例已行单纯椎间盘髓核摘除和神经减压复发者,采用MiTLIF翻修治疗并获得随访。男45例,女58例,平均53.4岁。采用MiTLIF和经皮椎弓根螺钉固定,其中单节段97例,双节段6例。收集分析手术时间、术中术后出血量、放射线暴露时间和并发症。采用视觉模拟量表(visual analog scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评估临床结果,末次随访时行腰椎动力位X线片和薄层CT扫描重建检查评价椎间融合情况。结果所有患者随访12～49个月,平均26.1个月。术中出血量为(358±67)mL,术后出血量为(52±20)mL,放射线暴露时间为(42±13)s。术前及末次随访腰痛VAS评分分别为6.3±2.5和0.7±0.3,术前及末次随访腿痛VAS评分分别为7.5±2.4和0.6±0.2,末次随访腰腿痛VAS评分与术前比较差异均有统计学意义(t=2.43及t=2.57,P<0.05)。术前及末次随访ODI分别为41.5±5.3和13.1±2.8,差异有统计学意义(t=4.39,P<0.01)。末次随访椎间融合率为95.2%(98/103)。发生神经根损伤4例,切口表浅感染4例,一过性下肢麻木12例,硬膜撕裂5例。结论针对初次单纯椎间盘髓核摘除和神经减压复发者,MiTLIF是一种安全有效的技术。

Objective To retrospectively analyze the clinical outcomes and complications of minimally invasive transforaminal lumbar interbody fusion（MiTLIF） as revision surgery in the treatment of lumbar degenerative lumbar diseases.Methods From March 2006 to November 2010,103 patients with recurrent lumbar degenerative diseases after primary discectomy and decompression were treated with MiTLIF and followed up.There were 45 males and 58 females with an average age of 53.4 years.During MiTLIF and percutaneous pedicle screw fixation,single level procedure was performed in 97 patients,and 2 level procedures were performed in 6 patients.The operative time,blood loss,X-ray exposure time and complications were recorded.Clinical outcomes were assessed by visual analog scale（VAS） scores and Oswestry disability index（ODI）.Fusion rates were determined by CT scan reconstruction and dynamic lumbar radiography at the final follow-up.Results The average follow-up lasted 26.1 months（range from 12 to 49 months）.The intraoperative and postoperative blood losses were（358±67） mL and（52±20） mL,respectively.The average radiation exposure time was（42±13） s.There was significant difference between VAS scores for low back pain before operation and at the final follow up（6.3±2.5 vs.0.7±0.3,t=2.43,P0.05）.So were the VAS scores for leg pain and the ODI（7.5±2.4 vs.0.6±0.2,t=2.57,P0.05;41.5±5.3 vs.13.1±2.8,t=4.39,P0.01）.The fusion rate at the final follow-up was 95.2%（98/103）.New nerve root injury occurred in 4 cases,superficial wound infection in 4 cases,transient leg numbness in 12 cases and dural tearing in 5 cases.Conclusion MiTLIF is a safe and effective procedure for recurrent lumbar degenerative diseases after primary discectomy and decompression.