[1]邢海清,苏寅,叶少奇,等.交叉MIS-TLIF联合经皮椎弓根螺钉治疗双节段腰椎管狭窄伴节段失稳症[J].中华老年骨科与康复电子杂志,2020,(01):48-53.[doi:10.3877/cma.j.issn.2096-0263.2020.01.009]
　Xing Haiqing,Su Yin,Ye Shaoqi,et al.Treatment of double-segment lumbar spinal stenosis with segmental instability with cross-MIS-TLIF combined with percutaneous pedicle screw[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2020,(01):48-53.[doi:10.3877/cma.j.issn.2096-0263.2020.01.009]
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交叉MIS-TLIF联合经皮椎弓根螺钉治疗双节段腰椎管狭窄伴节段失稳症()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2020年01期
页码:
48-53
栏目:
脊柱疾患
出版日期:
2020-02-05

文章信息/Info

Title:
Treatment of double-segment lumbar spinal stenosis with segmental instability with cross-MIS-TLIF combined with percutaneous pedicle screw
作者:
邢海清; 苏寅; 叶少奇; 缪晓晖
352100 福建中医药大学附属宁德市中医院骨科
Author(s):
Xing Haiqing;  Su Yin;  Ye Shaoqi;  Miao Xiaohui.
Department of Orthopedics, Fujian Ningde Hospital of TCM Affiliated to Fujian University of Traditional Chinese Medicine, Ningde 352100, China
关键词:
椎弓根钉;  腰椎失稳;  双节段腰椎管狭窄症;  MIS-TLIF
Keywords:
Pedicle?screws;  Lumbar instability;  Double segment lumbar spinal stenosis;  MIS-TLIF
DOI:
10.3877/cma.j.issn.2096-0263.2020.01.009
文献标志码:
A
摘要:
目的 探讨交叉MIS-TLIF联合经皮椎弓根螺钉治疗邻近双节段腰椎管狭窄伴节段失稳症患者的临床疗效。方法 选择腰椎管狭窄伴节段失稳症的患者79例，按入院先后顺序编号，按随机数分配表分为交叉MIS-TLIF联合经皮椎弓根螺钉治疗组（交叉组）48例、双侧传统MIS-TLIF治疗组（双侧组）31例，比较两组手术时间、术中出血量、术后引流量、住院时间。通过比较两组术前及术后3 d、7 d、3个月及末次随访时的腰痛视觉模拟（VAS）评分、术后1、3、6个月及末次随访时ODI指数、椎间融合率、临近节段退变率，来评估临床疗效。结果 交叉组的手术时间、术中出血量、术后引流量明显少于双侧组，差异有统计学意义（均P＜0.05）；两组术后住院时间相当，差异无统计学意义。两组术前及术后3 d、7 d、3个月及末次随访时的腰痛VAS评分显著优于术前（P＜0.01），术后3 d、7 d交叉组明显优于双侧组（P＜0.05），术后3个月及末次随访时差异无统计学意义。两组术前及术后1、3、6个月及末次随访时ODI指数均明显优于术前（P＜0.01），两组间比较差异无统计学意义，末次随访时椎间融合率、临近节段退变率，组间比较差异无统计学意义（P＞0.05）。结论 交叉MIS-TLIF联合经皮椎弓根螺钉治疗邻近双节段腰椎管狭窄伴节段失稳症患者，对腰椎后方复合体等解剖结构破坏少，术中及术后出血相对较少，两组间椎间融合率、临近节段退变率相当，同时避免了传统双侧MIS-TLIF置钉及安装纵棒的困难，简化手术操作，术后恢复快，手术效果显著。
Abstract:
Objective To explore the clinical efficacy of cross-MIS-TLIF combined with percutaneous pedicle screw in the treatment of adjacent double-segmental lumbar spinal stenosis with segmental instability. Methods 79 cases of lumbar spinal stenosis with segmental instability were selected. According to the sequence of admission, they were randomly divided into crossover MIS-TLIF combined with percutaneous pedicle screw treatment group (cross group, n=48) and bilateral traditional MIS-TLIF group (bilateral group, n=31). The operation time, intraoperative blood loss, postoperative drainage and hospital stay were compared between the two groups. The clinical effect was evaluated by comparing the visual analogue VAS score of low back pain before operation and 3 days, 7 days, 3 months and the last follow-up, the ODI index, the rate of interbody fusion and the rate of adjacent segment degeneration at 1, 3, 6 months after operation and the last follow-up. Results The operation time, intraoperative blood loss and postoperative drainage in the cross group were significantly less than those in the bilateral group (P<0.05), but there was no significant difference in postoperative hospital stay between the two groups (P>0.05). The visual analogue scale (VAS) of low back pain before operation and at 3 days, 7 days, 3 months and the last follow-up in the two groups was significantly better than that before operation, and that in the cross group was significantly better than that in the bilateral group at 3 days and 7 days after operation (P<0.01). There was no significant difference in VAS scores between the two groups at 3 months after operation and at the last follow-up (P<0.05). The ODI index before operation and 1,3,6 months after operation and at the last follow-up in both groups were significantly better than those before operation. There was no significant difference between the two groups in the rate of interbody fusion and the rate of adjacent segment degeneration at the last follow-up (P<0.05), and there was no significant difference in the rate of interbody fusion and the rate of adjacent segment degeneration between the two groups at the last follow-up (P<0.05). Conclusion Cross-MIS-TLIF combined with percutaneous pedicle screw in the treatment of adjacent double-segmental lumbar spinal stenosis with segmental instability has less damage to anatomic structures such as lumbar posterior complex, relatively less bleeding during and after operation, and the same rate of interbody fusion and adjacent segment degeneration between the two groups. at the same time, it avoids the difficulties of traditional bilateral MIS-TLIF screw placement and longitudinal rod installation, simplifies the operation, and the postoperative recovery is quick and the surgical effect is significant.

参考文献/References:

1 寇福新, 孙常太. 退行性腰椎管狭窄症的治疗进展 [J]. 中国脊柱脊髓杂志, 2013, 23(8): 756-759.2 陈思, 陈剑峰, 邵阳, 等. 量化动态X线检查在退变性腰椎不稳诊疗中的应用 [J]. 中国矫形外科杂志, 2018, 26(23): 2199-2203.3 陆永强, 徐跃根, 江春宇, 等. 通道下经椎间孔微创腰椎融合联合经皮椎弓根内固定治疗腰椎间盘突出伴腰椎不稳 [J]. 临床骨科杂志, 2015, 18(3): 296-298.4 周健, 滕学仁. Quadrant通道下微创经椎间孔腰椎椎体间融合术治疗腰椎间盘突出症的临床观察 [J]. 中国矫形外科杂志, 2015, 23(17): 1557-1561.5 Kong YS, Jang GU, Park S. The effects of prone bridge exercise on the Oswestry disability index and proprioception of patients with chronic low back pain [J]. Journal of Physical Therapy Science, 2015, 27(9): 2749-2752.6 陈晶祥, 周江军, 赵敏, 等. Quadrant通道微创TLIF治疗相邻双节段腰椎间盘突出症的疗效分析 [J]. 中国骨与关节损伤杂志, 2017, 32(1): 65-67.7 顾广飞, 张海龙, 贺石生, 等. 微创经椎间孔腰椎体间融合术治疗腰椎管狭窄合并腰椎不稳症 [J]. 中华外科杂志, 2011, 49(12): 1081-1085.8 Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis Four-Year results of the spine patient outcomes research trial [J]. Spine (Phila Pa 1976), 2010, 35(14): 1329-1338.9 腰椎管狭窄症手术治疗规范中国专家共识组. 腰椎管狭窄症手术治疗规范中国专家共识(2014年) [J]. 中华医学杂志, 2014, 94(35): 2724-2725.10 李全修, 杨学军, 陈晓东, 等. TLIF治疗老年多节段腰椎间盘突出并椎管狭窄症的疗效分析 [J]. 中国骨与关节损伤杂志, 2018, 33(1): 20-23.11 Lau D, Lee JG, Han SJ, et al. Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF) [J]. J Clin Neurosci, 2011, 18(5): 624-627.12 Tsahtsarlis A, Wood M. Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease [J]. Eur Spine J, 2012, 21(11): 2300-2305.13 Sim HB, MurovicJA, Cho BY, et al. Biomechanical comparison of single-level posterior versus transforaminal lumbar interbody fusions with bilateral pedicle screw fixation: segmental stability and the effects on adjacent motion segments[J]. J Neurosurg Spine, 2010, 12(6): 700-708．14 Xue H, Tu Y, Cai M. Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases [J]. Spine J, 2012, 12(3): 209-215.15 杜怡斌, 张之栋, 刘艺明, 等. MIS-TLIF与TLIF治疗双节段腰椎管狭窄症的疗效比较 [J]. 临床骨科杂志, 2017, 20(3): 289-292.16 侯正轩, 刘宁波, 袁文杰, 等. Wiltse入路椎弓根钉内固定术对脊柱结构和多裂肌功能的影响 [J]. 实用骨科杂志, 2018, 24(3): 205-210.

备注/Memo

备注/Memo:
宁德市科技局计划项目（20150122）
更新日期/Last Update: 2020-07-07