内镜辅助下经单侧腰椎间孔椎间融合内固定治疗复发性腰椎间盘突出症

Treatment of recurrent lumbar disc herniation by unilateral approach for transforaminal lumbar interbody fusion under microendoscope

目的分析并总结内镜辅助下经单侧腰椎间孔椎间融合内固定术治疗复发性腰椎间盘突出症(recurrent lumbar disc herniation,RLDH)的临床疗效。方法收集2012年1月-2016年1月间经手术治疗的46例RLDH患者的临床资料,按手术方式不同分为观察组(内镜辅助下经单侧椎间孔椎间融合内固定术)和对照组(传统后路经椎间孔椎间融合内固定术),分析两组围手术期相关指标、术后腰腿疼痛和功能改善情况、手术并发症及植骨融合率并进行比较。结果两组手术出血量、切口长度及术后住院时间比较差异有统计学意义(P<0.05),手术时间比较差异无统计学意义(P>0.05)。46例患者随访时间平均为18.2(13~32)个月。两组组内术后各时间点的VAS及ODI与术前比较差异均有统计学意义(P<0.05)。两组间术后1天腰、腿疼痛VAS评分比较差异有统计意义(P<0.05),但术后6个月及末次随访时的VAS评分及ODI比较差异无统计学意义(P>0.05)。末次随访时观察组植骨融合率为90.9%(20/22例),对照组为95.8%(23/24例),两组比较差异无统计学意义(P>0.05)。两组手术主要并发症包括脑脊液漏、对侧肢体疼痛、切口延迟愈合、融合器移位,其中,观察组6人次,对照组7人次,比较差异无统计学意义(P>0.05)。结论内镜辅助下经单侧椎间孔减压椎间融合内固定治疗RLDH能获得与传统手术相似的疗效,具有手术切口小、出血少、术后住院时间短等优点,但手术并发症不容忽视。

Objective To investigate surgical results of treatment of recurrent lumbar disc herniation by unilateral approach for transforaminal lumbar interbody fusion under microendoscope. Methods From Jan 2012 to Jan 2016,46 patients with recurrent lumbar disc herniation who underwent transforaminal lumbar interbody fusion by using two different approaches were retrospectively analyzed. The patients were classified into observation group （unilateral approach for transforaminal lumbar interbody fusion under microendoscope） and control group （traditional open transforaminal lumbar interbody fusion） according to the operative methods. The perioperative indexs, improvement of patient＇s pain and lumbar function,surgical complications and bone graft fusion rate in 2 groups were compared. Results There were significant differences on blood loss,skin incision lengths and postoperative hospital stay （P〈0.05）,but no significant differences on operative time between observation group and control group （P〉0.05）. All the 46 patients were followed up from 13 to 32 months （averaging 18.2 months）. The VAS andith the preoperation （P〈0.05）. There were significant differences on VAS score of lumbar and leg pain at 1 day between ODI of 2 groups at each time point postoperatively experienced improvement compared w 2 groups,but no differences on VAS score and the ODI was noted at 6 months and the final follow-up between 2 groups（P〈0.05）. The bone graft fusion rate of observation group and control group was 90.9% （20/22 cases） and 95.8%（23/24 cases） at the final follow-up respectively,which showed no statistical significance （P〉0.05）. The major surgical complications included cerebrospinal fluid leakage,the contralateral limb pain,incision delayed healing and fusion cage migration,which of 6 person-times in observation group and 7 person-times in control group. The incidence rate of complications was not obviously different in the 2 groups （P〉0.05）. Conclusion Treatment of recurrent lumbar disc herniation by unilateral approach for transforaminal lumbar interbody fusion under microendoscope can achieve the same clinical effects as traditional open surgery,and has some advantages including a small incision,less blood loss and shorter hospital stay,however,its complications should be well considered.