脊柱微创通道镜系统辅助改良经椎间孔腰椎椎间融合术治疗腰椎退行性疾病

摘要

目的：设计脊柱微创通道镜系统，探讨在此脊柱微创通道镜系统辅助下行改良经椎间孔腰椎椎间融合术（ transforaminal lumbar interbody fusion ，TLIF）治疗腰椎退行性疾病的疗效。方法2013年3月～2014年9月，对腰椎退行性疾病30例，在脊柱微创通道镜系统辅助下行改良TLIF。记录手术时间、术中出血量、术后引流量、术后下地时间及手术并发症；观察手术前后疼痛视觉模拟评分（visual analog scale，VAS）、日本骨科学会（Japanese Orthopaedic Association，JOA）评分、JOA改善率及椎间植骨融合情况。结果手术时间（125．9±20．8） min，术中失血量（170．6±30．5） ml，术后引流量（110．6±25．5）ml，术后下地时间（4．5±1．1）d。随访12～18个月，平均15个月。术后1周及末次随访时的腰痛、腿痛VAS和JOA评分较术前明显改善（ P＜0．01）；末次随访JOA评分改善率65．0％～92．0％，平均81．81％；植骨融合率96．7％（29／30）。均无神经根损伤、椎间隙感染及内植物松动断裂等并发症。结论脊柱微创通道镜系统辅助下行改良TLIF，创伤小，术后恢复快，并发症少，临床疗效满意，是治疗腰椎退行性疾病安全有效的微创方法。%Objective To design the minimally invasive spinal channel endoscope and to evaluate outcomes of modified transforaminal lumbar interbody fusion ( TLIF ) assisted by the minimally invasive spinal channel endoscope system for lumbar degenerative diseases . Methods From March 2013 to September 2014, 30 patients with lumbar degenerative diseases were treated . The operation time , intraoperative blood loss , postoperative drainage loss , postoperative sick-bed stay and postoperative complications were recorded .The clinical outcomes were evaluated by using the VAS and JOA scores before and after operation , JOA improvement rate, and bone fusion rate at the final follow-up. Results The mean operation time was ( 125.9 ±20.8 ) min, the mean intraoperative blood loss was ( 170.6 ±30.5 ) ml, the mean postoperative drainage was ( 110.6 ±25.5 ) ml, and the mean postoperative sick-bed stay was (4.5 ±1.1) d.The patients were followed up for a mean of 15 months (range, 12-18 months).The VAS and JOA at postoperative 1 week and the final follow-up were significantly improved as compared with the preoperation ( P<0.01).The average JOA improvement rate was 81.81%(range, 65.0%-92.0%), and the bony fusion rate was 96.7%(29/30) at the final follow-up.No intervertebral space infection , nerve root injury , instrument failure or other complications were observed . Conclusion Modified TLIF assisted by the minimally invasive spinal channel endoscope system is safe and effective , and it can afford satisfactory clinical outcomes for lumbar degenerative diseases , with advantages of minimal invasion , quick recovery and low complication rate .