| Quadrant通道下的MIS-TLIF治疗Ⅰ、Ⅱ度退行性腰椎滑脱的疗效研究 |
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投稿时间：2018-09-07
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| 作者 | Author | 单位 | Address | E-Mail |
| 文杰 |
WEN Jie |
甘肃中医药大学, 甘肃 兰州 730000 |
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| 杨阳 |
YANG Yang |
甘肃中医药大学, 甘肃 兰州 730000 |
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| 张辉 |
ZHANG Hui |
甘肃省人民医院, 甘肃 兰州 730000 |
People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China |
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| 刘林 |
LIU Lin |
甘肃省人民医院, 甘肃 兰州 730000 |
People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China |
1104856178@qq.com |
| 刘亚龙 |
LIU Ya-long |
陇西县第一人民医院, 甘肃 陇西 748100 |
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| 刘琰 |
LIU Yan |
兰州大学第二医院, 甘肃 兰州 730030 |
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| 王栋 |
WANG Dong |
甘肃中医药大学, 甘肃 兰州 730000 |
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| 王增平 |
WANG Zeng-ping |
甘肃省人民医院, 甘肃 兰州 730000 |
People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第3期，第199-206页 |
| DOI：10.3969/j.issn.1003-0034.2019.03.002 |
| 基金项目: |
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中文摘要:
目的：探讨Quadrant通道系统下微创TLIF（MIS-TLIF）在治疗Ⅰ、Ⅱ度退变性腰椎滑脱症中的优势。
方法：对2014年3月至2017年3月手术治疗的100例Ⅰ、Ⅱ度退变性腰椎滑脱症患者的临床资料进行回顾性分析，其中采用MIS-TLIF手术治疗50例（观察组），男19例，女31例；年龄44~73（49.83±15.46）岁；病程6个月~7年，平均（22.18±4.74）个月；L4滑脱30例，L5滑脱20例，滑脱椎体椎弓根均完整；Meyerding分级Ⅰ度滑脱29例，Ⅱ度滑脱21例。采用开放性经椎间孔腰椎椎体间融术（Open-TLIF）治疗50例（对照组），男23例，女27例；年龄40~77（50.67±14.36）岁；病程6个月~10年，平均（20.56±5.37）个月；L4滑脱33例，L5滑脱17例，滑脱椎体椎弓根均完整；Meyerding分级Ⅰ度滑脱34例，Ⅱ度滑脱16例。观察两组患者的手术时间、切口长度、术中出血量、术后引流量、术前及术后第1天血清肌酸激酶（CK-MM）水平；比较两组术前及术后的VAS评分（视觉模拟评分法）、JOA评分（腰椎评分标准）、ODI评分（Oswestry功能障碍指数）；根据影像学资料比较两组术前及术后第12个月（末次随访）的滑脱率、椎间隙高度及滑脱角；根据术后第6、12个月随访时的腰椎X线片和CT评价椎间融合情况；根据术后12个月腰椎功能MacNab标准评定疗效。
结果：所有患者获得随访，时间为12个月。观察组手术时间（118.48±21.97）min，手术切口长度（3.74±0.74）cm，术中出血量（148.78±32.32）ml，术后引流量（84.85±16.37）ml，CK-MM水平术前（72.31±9.79）μ/L、术后第1天（415.12±25.89）μ/L；对照组手术时间（115.40±11.94）min，手术切口长度（8.46±0.69）cm，术中出血量（219.27±48.33）ml，术后引流量（157.69±31.61）ml，CK-MM水平术前（75.48±10.73）μ/L、术后第1天（506.69±37.86）μ/L；观察组术中出血量、术后引流量、手术切口长度、术后第1天CK-MM水平均小于对照组（P<0.05），但手术时间及术前CK-MM水平两组比较差异无统计学意义（P>0.05）。术前ODI、VAS、JOA评分两组比较差异无统计学意义（P>0.05），术后两组ODI、VAS、JOA评分均较术前明显改善（P<0.05），并且术后观察组均优于对照组（P<0.05）；末次随访时同一组内滑脱率、滑脱角、椎间隙高度均较术前明显改善（P<0.05），但两组间比较差异无统计学意义（P>0.05）；术后第6、12个月椎间融合情况两组比较差异无统计学意义（P>0.05）；根据腰椎功能MacNab评定标准，观察组优40例，良7例，可3例；对照组优35例，良10例，可5例。观察组50例患者中1例发生切口渗出、延迟愈合；对照组50例患者中1例出现L5椎体右侧局部肌肉坏死、渗出，不同时间的3次分泌物细菌培养均提示阴性，再次手术彻底清创后取出右侧内固定装置，最后获得延迟愈合。
结论：Quadrant通道下的MIS-TLIF在手术治疗Ⅰ、Ⅱ度退变性腰椎滑脱症中创伤小、出血少、功能恢复快和效果好。 |
| 【关键词】Quadrant通道 微创 经椎间孔腰椎椎体间融合 退行性腰椎滑脱 |
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| Treatment of gradeⅠandⅡdegree degenerative lumbar spondylolisthesis with minimally invasive surgery-transforaminal lumbar interbody fusion under Quadrant channel |
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ABSTRACT
Objective:To investigate the advantages of minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF) under Quadrant channel in the treatment of gradeⅠandⅡdegree degenerative lumbar spondylolisthesis.
MethodsThe clinical data of 100 patients with gradeⅠandⅡdegree degenerative lumbar spondylolisthesis treated from March 2014 to March 2017 were retrospectively analyzed. Among them,50 patients were treated with MIS-TLIF,including 19 males and 31 females,aged from 44 to 73 years old with an average of (49.83±15.46) years old;course of disease from 6 months to 7 years with the mean of (22.18±4.74) months;L4 slippage was in 30 cases and L5 slippage was in 20 cases,the slippage vertebral pedicles were intact;according to Meyerding classification,29 cases ofⅠdegree slip and 21 cases ofⅡdegree slip. Other 50 patients were treated with open-transforaminal lumbar interbody fusion(OPEN-TLIF),including 23 males and 27 females,aged from 40 to 77 years old with an average of(50.67±14.36) years old;course of disease from 6 months to 10 years with the mean of (20.56±5.37) months;L4 slippage was in 33 cases and L5 slippage was in 17 cases,the slippage vertebral pedicles were intact;according to Meyerding classification,34 cases ofⅠdegree slip and 16 cases ofⅡdegree slip. The operation time,length of surgical incision,intraoperative blood loss,postoperative drainage,and serum creatine kinase(CK-MM) levels before surgery and 1 day after surgery were observed. Visual analogue scale(VAS),Japanese Orthopedic Association Score (JOA),and Oswestry dysfunction index (ODI) were compared between the two groups before and after surgery. According to the imaging data,the slip rate,intervertebral space height and slip angle of the two groups before and 12 months (last follow-up) were compared. Intervertebral fusion was evaluated according to lumbar X-ray and CT at 6 and 12 months postoperatively. The clinical effect was evaluated according to the MacNab criteria at 12 months after surgery.
ResultsAll the patients were followed up for 12 months. In MIS-TLIF group,operation time,length of surgical incision,intraoperative blood loss,postoperative drainage were (118.48±21.97) min,(3.74±0.74) cm,(148.78±32.32) ml,(84.85±16.37) ml,respectively,CK-MM level was (72.31±9.79)μ/L before surgery and (415.12±25.89) μ/L at the first day after surgery. In OPEN-TLIF group,operation time,length of surgical incision,intraoperative blood loss,postoperative drainage were (115.40±11.94) min,(8.46±0.69) cm,(219.27±48.33) ml,(157.69±31.61) ml,respectively,CK-MM level was (75.48±10.73)μ/L before surgery and (506.69±37.86) μ/L at the first day after surgery. The intraoperative blood loss,postoperative drainage volume,length of surgical incision,and CK-MM level on the first postoperative day were lower in MIS-TLIF group than in OPEN-TLIF group(P<0.05),but the operation time and preoperative CK-MM levels were compared between two groups,the difference was not statistically significant (P>0.05). There were no significant differences in ODI,VAS,and JOA scores before surgery(P>0.05). The ODI,VAS,and JOA scores were significantly improved after surgery(P<0.05),and the scores of MIS-TLIF group were better than those of OPEN-TLIF group(P<0.05). At the last follow-up,the slip rate,slip angle and intervertebral space height were significantly improved in the same group(P<0.05),but there was no significant difference between two groups(P>0.05). There was no significant difference in intervertebral fusion between groups at 6 and 12 months after operation(P>0.05). According to the MacNab standard,40 cases got excellent results,7 good,3 fair in MIS-TLIF group,and 35 cases got excellent results,10 good,5 fair in OPEN-TLIF group. One patient had incision exudation and delayed healing in MIS-TLIF group. And in OPEN-TLIF group,1 patient had local muscle necrosis on the right side of L5 and the bacterial culture of the secretions was negative in the different three times and the right internal fixation device was taken out after the second operation completely debridement,and finally obtained delayed healing.
ConclusionThe MIS-TLIF under Quadrant channel has advantage of minimally invasive trauma,less bleeding,faster function recovery and better effect in surgical treatment of gradeⅠandⅡdegree degenerative lumbar spondylolisthesis. |
| KEY WORDS Quadrant channel Minimally invasive Transforaminal lumbar interbody fusion Degenerative lumbar spondylolisthesis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 文杰,杨阳,张辉,刘林,刘亚龙,刘琰,王栋,王增平.Quadrant通道下的MIS-TLIF治疗Ⅰ、Ⅱ度退行性腰椎滑脱的疗效研究[J].中国骨伤,2019,32(3):199~206 |
| 英文格式: | WEN Jie,YANG Yang,ZHANG Hui,LIU Lin,LIU Ya-long,LIU Yan,WANG Dong,WANG Zeng-ping.Treatment of gradeⅠandⅡdegree degenerative lumbar spondylolisthesis with minimally invasive surgery-transforaminal lumbar interbody fusion under Quadrant channel[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(3):199~206 |
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