小切口经腹膜外前路腰椎椎间融合术治疗复发性腰椎间盘突出症的长期随访研究

A long-term follow-up study of small incision extraperitoneal anterior lumbar interbody fusion in treatment of re-current lumbar disc herniation

目的观察小切口经腹膜外前路腰椎椎间融合术治疗复发性腰椎闾盘突出症的远期疗效。方法选择河南大学淮河医院2012年5月至2013年5月收治的40例接受小切口经腹膜外前路腰椎椎间融合术治疗的复发性腰椎间盘突出症患者，记录患者的手术时间、术中出血量、术后引流量及住院时间。分别于手术后1周、3个月、6个月及12个月对患者实施随访调查，采取功能障碍指数（ODI）及疼痛视觉模拟（VAS）评分量表对融合术治疗复发性椎间盘突出症的远期疗效进行评价。结果所有患者均成功接受手术治疗，手术时间（1．8±0．2）h，手术出血量（126．1±40．3）ml，术后引流量（47．4±7．5）ml，住院时间（6．6±1．7）d。所有患者均成功实施为期1年随访调查，术后1年患者VAS评分（1．5±0．8）分，明显低于术前（P〈0．05）；且术后1年其ODI指数为（6．5±1．2）％，较术前降低幅度明显（P〈0．05）。结论在复发性腰椎间盘突出症患者的临床治疗中，采用小切口经腹膜外前路腰椎椎间融合术治疗，远期疗效显著，且可降低患者术中出血量，缩短手术时间，有其微创性优势，值得推广。

Objective To observe the long term effect of small incision extraperitoneal anterior lumbar interbody fusion on recurrent lumbar disc herniation. Methods Forty recurrent lumbar disc herniation patients accepted small inci- sion extraperitoneal anterior lumbar interbody fusion treatment from May 2012 to May 2013 were selected, recorded the op- eration time, hemorrhage during the operation, the amount of postoperative drainage and hospitalization time. The followed- up investigation for 1 week, 3 months, 6 months and 12 months after operation were implementation of all patients, took disability index （ODI） and visual analogue scale （VAS） to evaluated the long-term effect of the fusion for recurrent lumbar disc herniation. Results All patients successfully underwent surgery, the operative time was （ 1.8 ±0. 2） h, the amount of hemorrhage was （ 126. 1 ±40. 3） ml, postoperative drainage was （47.4 ±7. 5） ml, the hospitalization time was （6. 6± 1.7） d. All patients were successful implementation of a 1 year follow-up, 1 year after surgery, patients＇ VAS score was 1.5 ± 0. 8, which was significantly lower than that before operation （ P 〈 0. 05 ） ; and ODI index was （ 6. 5 ± 1.2 ） %, which was significantly decreased than that preoperative （P 〈 0. 05）. Conclusions In clinical treatment of recurrent lum- bar disc herniation patients, the long-term curative effect of small incision extraperitoneal anterior lumbar interbody fusion is remarkable, it can reduce the volume of hemorrhage during operation, shorten operation time, has minimally invasive ad- vantages, is worthy of promotion.