经皮微创经椎间孔腰椎体间融合术治疗腰椎退变性疾病的临床疗效分析

Outcomes of minimally invasive percutaneous transforaminal lumbar interbody fusion for lumbar degenerative diseases

目的总结经皮微创经椎间孔腰椎椎体间融合术（MIS-TLIF）治疗腰椎退行性疾病的并发症,评估其临床疗效和安全性。方法自2010-05—2011-05采用MIS-TLIF治疗腰椎退行性疾病100例,记录手术时间、出血量、术后下床活动时间、住院时间和手术相关并发症;临床疗效评估采用VAS评分和腰椎JOA功能评分。结果随访时间18~36个月,平均23个月。手术时间95~195 min,平均125 min;出血量150~380 ml,平均210 ml;下床时间5~10 d,平均7 d,住院时间4~15 d,平均7 d;VAS评分由术前5~10分降低到末次随访时0~5分;JOA评分由术前的6~21分提高到术后23~29分;JOA评分改善率43%~92%,平均79%。2.5%（11/435）发生螺钉位置不良,1.7%（2/120）出现cage位置不良;0.8%（1/120）发生cage再移位;0.8%（1/120）的患者需要输血;2%（2/100）出现深静脉血栓;所有患者均未出现手术部位感染和脑脊液漏。结论采用MIS-TLIF治疗腰椎退行性疾病安全、可靠,并发症较低。

Objective To summarize complications of the minimally invasive percutaneous transforaminal lumbar interbody fusion（MIS-TLIF） for treatment of lumbar degenerative diseases, and assess the clinical outcomes and safety. Methods Between May 2010 and May 2011, 100 patients with lumbar degenerative diseases were treated using MIS-TLIF. The operative time, blood loss, postoperative ambulation time,the length of hospital and surgery-related complications were recorded; clinical outcomes were assessed using the VAS and JOA functional scores. Results The mean follow-up was 23months（18-36 months）. The mean operative time, bleeding volume, ambulation time, and the length of hospital were 125 min（95-195 min）, 210 ml（150-380 ml）, 7 days（5-10 days）, and 7 days（4-15 days）, respectively. The VAS score improved from preoperative 5-10 points to postoperative 0-5 points; JOA score improved from preoperative 6-21 points to postoperative 23-29 points. The mean JOA improvement rate was 79%（43%-92%）. The complications included 2.5%（11/435） screw malposition, 1.7%（2/120） cage malposition, 0.8%（1/120） post-operative cage migration, 0.8%（1/120） of patients requiring transfusions, 2%（2/100） appears deep vein thrombosis. No patients experienced surgical site infection and cerebrospinal fluid leakage. Conclusion The rate of complications from MIS-TLIF is low, which is a safe and effective surgery.