微创经椎间孔腰椎间融合术治疗腰椎退变性疾病

Clinical outcome of minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative disease

目的探讨微创经椎间孔腰椎间融合术（MIS-TLIF）治疗腰椎退变性疾病的可行性和早期疗效。方法采用MIS-TLIF治疗30例腰椎退变性疾病患者,其中Ⅰ~Ⅱ度退行性或峡部裂型腰椎滑脱症12例,退行性腰椎管狭窄伴节段性不稳8例,腰椎间盘突出症10例。均为单节段融合。结果手术时间127~209（168±41）min;术中出血量23~361（192±169）ml;术中X线照射时间72~136（104±32）s;术后首次下床活动时间1.4~3.8（2.6±1.2）d。疼痛VAS评分术前（7.20±1.02）分,末次随访（1.71±0.66）分,差异有统计学意义（P〈0.01）。末次随访椎间融合率为100%。未发生并发症。X线片显示cage无移位、松动、下沉,椎弓根钉无松动、折断。结论 MIS-TLIF对腰椎的解剖结构破坏小,对椎旁肌肉的剥离少,患者术后恢复快,是一种有效、安全、损伤较小的手术方法,可用于腰椎不稳、局限节段椎间盘病变、≤Ⅱ度以下腰椎滑脱的患者;但手术时间较长,医患X线暴露较多。

Objective To investigate the feasibility and early curative effect of minimally invasive transforaminal lumbar interbody fusion（ MIS-TLIF） in the treatment of low lumbar degenerative disease. Methods A total of 30 patients underwent MIS-TLIF for low lumbar degenerative disease. They contained 12 cases of Ⅰ ~ Ⅱdegree spondylolisthesis,8 cases of degenerative lumbar spinal stenosis with segmental instability and 10 cases of protrusion of lumbar intervertebral disc. All the patients underwent one-level fusion by the same surgeon. Results The surgical time,intraoperative blood loss volume,X-ray exposed time and the first leaving bed time after surgery were 127 ~ 209（ 168 ±41） min,23 ~ 361（ 192 ± 169） ml,72 ~ 136（ 104 ± 32） s,1. 4 ~ 3. 8（ 2. 6 ± 1. 2） d. VAS of the preoperative and the last follow-up were（ 7. 20 ± 1. 02） points and（ 1. 71 ± 0. 66） points,the difference had statistical significance（ P 〈0. 01）. The rates of fusion and complication incidence were 100% and 0% at the last follow-up. The X-ray film showed that the cage in intervertebral space was in good position and pedicle screws had not any displacement or snap. Conclusions MIS-TLIF is appropriate for Ⅰ ~ Ⅱ degree spondylolisthesis,degenerative lumbar spinal stenosis and protrusion of lumbar intervertebral disc and has an advantage of less blood loss and trauma. But it takes more time to finish the operation and X-ray exposing time is more.