| 汪小军,秦入结,任春朋,等.症状侧经椎间孔腰椎间融合术联合对侧减压术治疗腰椎管狭窄症并腰椎不稳近期疗效观察[J].安徽医药,2019,23(10):2022-2025. |
| 症状侧经椎间孔腰椎间融合术联合对侧减压术治疗腰椎管狭窄症并腰椎不稳近期疗效观察 |
| Short?term therapeutic effect of modified TLIF combined with contralateral Wiltse decompression for the treatment of bilateral lumbar spinal stenosis with lumbar instability |
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| DOI：10.3969/j.issn.1009?6469.2019.10.029 |
| 中文关键词: 椎管狭窄 脊柱融合术 椎板切除术 腰椎 关节不稳定性 椎旁肌间隙入路 |
| 英文关键词: Spinal stenosis Spinal fusion Laminectomy Lumbar vertebrae Joint instability Paravertebral muscle space approach(Wiltse approach) |
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| 中文摘要: |
| 目的探讨改良经椎间孔腰椎间融合术( transforaminal lumbar interbody fusion，TLIF)联合对侧多裂肌与最长肌之间间隙( Wiltse入路)潜行减压术治疗腰椎管狭窄症合并腰椎不稳的近期疗效。方法对 2014年 7月至 2017年 10月徐州医科大学附属连云港医院 32例采用改良 TLIF联合对侧 Wiltse入路潜行减压术治疗腰椎管狭窄合并腰椎不稳的病人资料进行回顾性分析，记录及比较术前、末次随访时腰腿痛视觉模拟评分( visual analogue score，VAS)，腰椎功能评分( Japanese orthopedic associa? tion，JOA)，Oswestry功能障碍指数( oswestry dysfunction index，ODI)椎间高度，植骨融合及并发症发生情况等。结果随访时间范围为 6~22个月，平均 11.3个月。 32例均获得完整随访，手术时间，(120.57±13.46)min，术中出血量( 148.75±30.35)mL，术后引流量( 151.55±53.86)mL，骨性愈合时间为( 5.71±1.00)个月。术后腰腿痛 VAS评分、 JOA评分、 ODI指数及椎间高度较术前均明显改善( P＜0.05)。末次随访 JOA评分改善优良率为 90.6%，X线检查显示椎间融合率为 96.9%(31/32)。并发症发生率为 9.4%(3/32)，其中 1例病人出现患侧上位神经根损伤， 1例出现对侧神经根损伤， 1例脑脊液漏，无内固定失效及感染等并发症发生。结论改良 TLIF并对侧 Wiltse入路潜行减压术治疗腰椎管狭窄并腰椎不稳近期疗效满意；在保证有效减压及安全的条件下，更多的保留了脊柱后方的骨与软组织，降低慢性腰背部疼痛及对侧根性疼痛症状发生率，值得在临床上推广应用。 |
| 英文摘要: |
| Objective To evaluate the short ? term clinical results of modified transforaminal lumbar interbody fusion(TLIF) with contralateral Wiltse approach decompression in lumbar spinal stenosis with instability.Methods Thirty?two cases of lumbar spinal stenosis with instability，treated with modified TLIF combined with contralateral Wiltse approach decompression at Lianyun?gang Hospital Affiliated of Xuzhou Medical University from July 2014 to October 2017，were analyzed retrospectively.The visual an? alogue score(VAS) of lumbago?leg pain，the Japanese orthopedic association(JOA)score，oswestry dysfunction index(ODI) and the height of intervertebral discs，implanted bone fusion and complications were recorded and compared between the twogroups at preoperation and the latest follow?up.Results All 32 cases were followed up for 6 to 22 months with an average of 11.3 months.The operation time，blood loss，postoperative drainage，and fracture healing time were(120.57±13.46) min，(148.75± 30.35) mL，(151.55±53.86) mL and(5.71±1.00)months，respectively.The VAS score of lumbago?leg pain，the JOA score， the ODI and the height of intervertebral discs were significantly improved postoperatively in the two groups compared with preopera?tion(P＜0.05).The JOA improvement rate at the latest follow?up was 90.6% and X?ray test showed that the intervertebral fusion rate was 96.9%(31/32).The incidence of complications was 9.4%(3/32).There was no case of loosening of instrumentation or in? fection，but there were one case with upper nerve root injury on the affected side，one case with contralateral nerve root injury and one case with cerebrospinal fluid leakage.Conclusions The modified TILF with Wiltse approach decompression is effective in thesurgical treatment of lumbar spinal stenosis with instability.Under the condition of ensuring effective decompression and safety， more bones and soft tissues are preserved，which lowers the incidence of chronic low back pain and contralateral nerve root injury， therefore is worthy of clinical application. |
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