改良骨膜下入路经椎间孔腰椎椎间融合术治疗腰椎间盘突出症

Treatment of Lumbar Disc Herniation with Modified Subperiosteal Approach through Intervertebral Foramen and Lumbar Interbody Fusion

目的:探讨改良骨膜下入路经椎间孔腰椎椎间融合术(TLIF)治疗腰椎间盘突出症(LDH)的临床疗效。方法:对2016年8月至2018年8月本院66例LDH患者,采用改良骨膜下入路TLIF治疗,记录围术期相关指标及并发症发生情况,术前、术后1d、3个月、1年评价疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI),比较术前及术后1年椎旁肌脂肪浸润程度及肌面积。结果:所有患者均完成手术,手术时间(129.89±11.83)min,术中出血量(165.49±19.36)mL,引流量(138.39±19.24)mL,住院(6.04±1.20)d。术后发生1例慢性腰背痛,1例切口感染。术后1d,术后3个月及术后1年VAS评分和ODI评分均显著降低,差异有统计学意义(P<0.05)。术后1年椎旁肌脂肪浸润程度及肌面积与术前差异无统计学意义(P>0.05)。结论:改良骨膜下入路TLIF治疗LDH能获得良好的临床疗效,手术创伤小,并发症发生率低,能降低椎旁肌肉萎缩。

Objective:To explore the clinical effect of modified subperiosteal approach through intervertebral foramen and lumbar interbody fusion(TLIF)in the treatment of lumbar disc herniation(LDH).Methods:66patients with LDH in our hospital from August 2016to August 2018were selected as the study subjects,and all patients were treated by modified subperiosteal approach TLIF.The related perioperative indicators and the occurrence of complications were recorded.The preoperative and postoperative 1d,3months,1year evaluation pain visual analogue scale(VAS)score and Oswestry dysfunction index(ODI)were compared between the two groups.The fat infiltration degree and muscle area of paraspinal muscles were compared before and 1year after operation.Results:All patients’operation were completed,the operation time was(129.89±11.83)min,intraoperative blood loss(165.49±19.36)mL,drainage volume(138.39±19.24)mL,hospitalization(6.04±1.20)d.1case showed chronic low back pain,and 1case incision infection occurred after operation.The VAS score and ODI at 1d,3months and 1year after operation were decreased with statistically significant difference(P<0.05).There was no statistically significant difference in the degree of fat infiltration and muscle area of paravertebral muscle 1year after operation(P>0.05).Conclusion:Modified subperiosteal approach TLIF can obtain good clinical efficacy in the treatment of LDH,with less surgical trauma and low complication rate,and can reduce paravertebral muscle atrophy.