微创经椎间孔椎体间融合术治疗腰椎间盘突出症伴腰椎不稳

Clinical outcome of mini-open transforaminal lumbar interbody fusion to treat lumbar disc protrusion with instability of lumbar vertebrae

目的:通过与传统开放手术进行比较,探讨微创经椎间孔椎体间融合术(mini-open transforaminallumbar interbody fusion,mini-TLIF)治疗腰椎间盘突出症伴腰椎不稳的临床效果。方法:2011年1-10月,采用经Mast Quadrant通道下减压联合经皮椎弓根螺钉固定(Sextant)微创治疗腰椎间盘突出症伴腰椎不稳19例,传统开放手术治疗24例。比较两组手术出血量、手术前后腰腿痛VAS评分、JOA评分、腰椎前凸角(lumbar lordosis angle,LLA)及腰椎活动度(range of movement,ROM)。结果:本组所有病例都得到5～12个月随访,平均8.9个月,其中,微创组手术出血量为50～380mL,平均177mL,开放组手术出血量为400～1240mL,平均706mL,差异有统计学意义(P<0.001);两组术后一周及末次随访时腰、腿痛VAS评分与治疗前比较均显著降低,差异有统计学意义(P<0.001),术后一周及末次随访时微创组腰痛VAS评分较开放组更低(P<0.001),术后1周及末次随访时两组腿痛VAS评分比较差异无统计学意义(P>0.05),末次随访时两组JOA评分比较差异无统计学意义(P>0.05),微创组末次随访时腰椎前凸角及腰椎活动度均大于开放组(P<0.05)。结论:经Quadrant通道下减压联合经皮椎弓根螺钉固定(Sextant)微创治疗腰椎间盘突出症伴腰椎不稳具有创伤小、手术出血少、术后疼痛轻、更好的保留腰椎曲度及活动度等特点,是一种有效的方法。

Objective To investigate the clinical efficacy of mini-open transforaminal lumbar interbody fusion （Mini-TLIF） assisted by Mast Quadrant and Sextant system to treat lumbar disc protrusion with instability of lumbar vertebrae,in comparison with the traditional open-TLIF. Methods From January 2011 to October 2011, 43 patients with lumbar disc protrusion and instability of lumbar vertebrae were enrolled, 19 patients received Mini-TLIF that assisted by Mast Quadrant and Sextant system, and 24 patients received traditional open-TLIF. Hemorrhage amount, VAS score, JOA score, lumbar lordosis angle and range of movement were calculated. Results All patients were followed up for an average of 8.9 months （range from 5 to 12 months）, Mini-TLIF group got hemorrhage amount at an average of 177 mL （ range from 50 to 380 mL）, and open-TLIF group got 706 mL （range from 400 to 1 240 mL） （P 〈 0.001 ）. VAS score of lumbar pain decreased significantly in both two groups （P 〈 0.001 ）, especially in the group of Mini-TLIF. VAS score of leg pain decreased significantly in both two groups （P 〈 0.001 ）, with no significant difference between these two groups. There was no difference in JOA scores was found between these two groups at final follow-up. Better Lumbar lordosis angle and range of movement were shown in the Mini-TLIF group at final follow-up（P 〈 0.05）. Conclusion Mini-TLIF that assisted by Mast Quadrant and Sextant system has less injury, ,less hemorrhage amount, less pain and better Lumbar lordosis angle and range of movement in the treatment of lumbar disc protrusion with instability of lumbar vertebrae.