微创经椎间孔腰椎间融合术联合经皮椎弓根螺钉内固定长节段融合术治疗退行性腰椎侧弯

目的 探讨微创经椎间孔腰椎间融合术（MIS-TLIF）联合经皮椎弓根螺钉内固定长节段融合术治疗退行性腰椎侧弯的临床疗效。方法 采用MIS-TLIF联合经皮椎弓根螺钉内固定长节段融合术治疗17例退行性腰椎侧弯患者,比较术前和术后1周、3个月、末次随访时视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和36条简明健康状况调查表（SF-36）评分,以及X线测量冠状位Cobb角、矢状位前凸角、冠状位和矢状位躯干偏移,X线或CT判断椎体融合率,MRI评价减压程度。结果 17例患者手术融合56个椎体节段（T12~S1节段）;平均手术时间200 min,术中出血量320 ml,住院时间8.21...

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Published in中国现代神经疾病杂志 Vol. 16; no. 4; pp. 197 - 203
Main Author 吴浩 王曲 林彦达 张璨 管凤增
Format Journal Article
LanguageChinese
Published 首都医科大学宣武医院神经外科, 北京,100053 2016
Subjects
SH词
内固定术（非Me
外科手术,微创性
脊柱侧凸
脊柱融合术
腰椎
脊柱侧凸
脊柱融合术
Surgical procedures,minimally invasive
Scoliosis
外科手术,微创性
Lumbar vertebrae
腰椎
内固定术(非MeSH词)
Spinal fusion
Internal fixation (not in MeSH)
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ISSN1672-6731
DOI10.3969/j.issn.1672-6731.2016.04.005

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Summary:目的 探讨微创经椎间孔腰椎间融合术（MIS-TLIF）联合经皮椎弓根螺钉内固定长节段融合术治疗退行性腰椎侧弯的临床疗效。方法 采用MIS-TLIF联合经皮椎弓根螺钉内固定长节段融合术治疗17例退行性腰椎侧弯患者,比较术前和术后1周、3个月、末次随访时视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和36条简明健康状况调查表（SF-36）评分,以及X线测量冠状位Cobb角、矢状位前凸角、冠状位和矢状位躯干偏移,X线或CT判断椎体融合率,MRI评价减压程度。结果 17例患者手术融合56个椎体节段（T12~S1节段）;平均手术时间200 min,术中出血量320 ml,住院时间8.21 d,术后随访12.13个月。与术前相比,术后1周、3个月和末次随访时VAS（均P=0.000）和ODI（均P=0.000）评分均减少,SF-36评分增加（均P=0.000）,冠状位Cobb角（均P=0.000）、矢状位前凸角（均P=0.000）、冠状位和矢状位躯干偏移（均P=0.000）均减小。至末次随访时,ODI改善率（86.51±6.02）%,椎体融合率达89.21%,且螺钉位置良好。无一例出现术后神经功能缺损、感染、脑脊液漏等严重并发症,无一例内固定失败、椎弓根螺钉和钛棒断裂或Cage移位,无死亡病例。结论 MIS-TLIF联合经皮椎弓根螺钉内固定长节段融合术治疗退行性腰椎侧弯具有手术创伤小、术中出血量少、并发症发生率低、矫形效果好、疗效确切等优点,尽管存在手术时间和学习曲度较长等缺点,但仍是退行性腰椎侧弯微创治疗的有效方法。
Bibliography:WU Hao, WANG Qu, LIN Yan-da, ZHANG Can, JIAN Feng-zeng Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Objective To discuss the operative essentials and therapeutic effects of minimally invasive transforaminal lumbar interbody fusion （MIS- TLIF） combined with percutaneous pedicle screw fixation for degenerative lumbar seoliosis （DLS）. Methods A total of 17 DLS patients without prior spinal diseases were treated by MIS- TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University. The operation time, intraoperative blood loss, hospital stay, and postoperative complication were recorded in each patient. Visual Analogue Scale （VAS） and Oswestry Disability Index （ODI） were used to evaluate postoperative improvement of low back and leg pain, and clinical effects were assessed according to Medical Outcome Study 36-hem Short-Form Health Survey （SF- 36）. Coronal Cobb angle, sagittal lordosis angle and spin
ISSN:1672-6731
DOI:10.3969/j.issn.1672-6731.2016.04.005