两种入路联合固定融合治疗腰椎退行性疾病的早期并发症分析

Comparison analysis of perioperative period complications of combined fixation and interbody fusion for the treatment of lower lumbar degenerative diseases via two different approaches

目的比较正中入路小切口与通道下经肌间隙入路联合固定并椎间融合治疗腰椎退行性疾病的早期并发症。方法采用传统正中入路小切口单侧椎弓根螺钉+瞄准器引导下对侧椎板关节突螺钉联合固定并椎间融合(小切口组)治疗166例腰椎退行性疾病患者,采用通道下经肌间隙入路下同样的联合固定融合技术(通道组)治疗112例腰椎退行性疾病患者。对两组早期并发症进行比较。结果小切口组和通道组并发症病例数分别为22例(13. 25%)、37例(33. 04%),差异有统计学意义(P <0. 01);在发生任意并发症、仅发生次要并发症、切口愈合问题及其他并发症4项中,通道组发生率均高于小切口组(P <0. 05)。结论应用单侧椎弓根螺钉+经皮对侧椎板关节突螺钉联合固定并椎间融合术治疗腰椎退行性疾病,术后早期并发症发生率通道组明显高于小切口组,主要发生神经损伤及切口皮肤问题。通道下手术存在明显的学习曲线,应选择合适病例,严谨操作。

Objective To compare the perioperative complications associated with a combined fixation and interbody fusion for treating lower lumbar degenerative diseases（LLDD） via the median approach or minimally invasive ap- proach. Methods The 166 patients with LLDD underwent unilateral pedicle screw fixation combined with contralater-al percutaneous translaminar facet screw fixation and lumbar interbody fusion via median approach （ small incision group） ;112 patients with LLDD underwent the same fixation and lumbar interbody fusion by minimally invasive ap-proach（MI approach group）. The perioperative complications of the two groups were compared. Results In the small incision group, perioperative complications occurred in 22 cases （ 13.25 % ）, compared with 37 cases （33.04 % ） in the MI approach group,there was statistical difference（ P 〈 0. 01 ）. In the items of had any complication, only had minor complication, had incision problem and had other complications, MI approach group had higher incidence rate than small incision group （ P 〈 0. 05 ）. Conclusions The incidence rate of perioperative complications is obviously higher in the MI approach group than in the small incision group, using the combined fixation and interbody fusion to treat LLDD, especially in the complications of nerve injury and problems of incision. The MI approach surgery has steep learning curve, surgeons should choose appropriate cases and operate cautiously.