MIS-TLIF治疗复发性腰椎间盘突出症的短期疗效分析

摘要

Objective To explore the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of recurrent intervertebral disc hemiation.Methods 25 recurrent intervertebral disc herniation patients who received MIS-TLIF treatment from March 2011 to March 2014 were enrolled in this study.There were 15 males and 10 females,with an average age of 51.4 years (33 to 71 years).Among them.13 patients underwent L4/5 fusion,12 patients underwent L5/S1 fusion;14 patients received posterior approach discectomy previously,11 patients received endoscopic discectomy previously,the average time of recurrence was 24.4 months (7 to 72 months).The intraoperative blood loss,operative time,and perioperative complications were recorded.Visual analogue scale (VAS)and Oswestry disability index (ODI) score were used to evaluate the clinical outcome and lumbar X-ray was used to observe the intervertebral fusion at the final follow-up.Results The average follow-up time was 16.2 months (12 to 24 months),the average intraoperative blood loss was (310±50) mL,the average postoperative drainage volume was (85± 15) mL.The preoperative and final follow-up VAS scores of back pain were (6.8±2.4) and (0.9±0.2) respectively,the preoperative and final follow-up VAS scores of leg pain were (7.6±1.2) and (1.1±0.3) respectively,the difference between the final follow-up and preoperative VAS scores was significant (t=12.25,t=26.3,P＜0.05).The preoperative and the final follow-up ODI score were (44.2±4.7) and (12.3±1.4) respectively,and the difference was significant (t=32.58,P＜0.05).All patients demonstrated evidence of fusionat at the final follow-up,and there was no internal fixation loosening or fracture.Nerve root injury was occurred in 1 case,dural tear was observed in 1 case,contralateral lower limb pain was occurred in 1 case.Conclusion For recurrent intervertebral disc herniation,MIS-TLIF is a safe and effective treatment method in short term,and it still needs further study with large sample and long time follow-up.%目的 探讨分析微创经椎间孔椎间融合内固定术(MIS-TLIF)在复发性腰椎间盘突出症中的应用及临床疗效.方法 回顾性分析自2011年3月～2014年3月应用MIS-TLIF治疗的25例复发性腰椎间盘突出症患者,男性15例,女性10例,平均年龄51.4岁(33～71岁).其中L4/513例,L5/S112例,初次接受椎板开窗髓核摘除术14例,经椎间孔镜髓核摘除术11例,复发时间为24.4月(7～72月),记录患者的术中出血量、手术时间及围手术期并发症等一般情况;采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评分评估临床结果,末次随访时行腰椎X线片评价椎间融合情况.结果 25例随访时间12～24个月,平均16.2个月.术中出血平均为(310±50)mL,术后引流量平均为(85±15) mL.术前及末次随访腰痛VAS评分分别为(6.8±2.4)分和(0.9±0.2)分,术前及末次随访腿痛VAS评分分别为(7.6±1.2)分和(11±0.3),末次随访腰腿痛VAS评分与术前比较均有显著性差异(t=12.25及t=26.3,P＜0.05).术前及末次随访ODI评分分别为(44.2±4.7)分和(12.3±1.4)分,差异有显著性(t=32.58,P＜0.05).末次随访椎间融合均融合,未见内固定松动及断裂等.发生神经根损伤1例,硬膜撕裂1例,对侧一过性下肢疼痛1例.结论 对于复发性椎间盘突出症MIS-TLIF是一种安全有效的治疗技术,短期随访疗效肯定,尚需进一步大样本及长时间随访结果的验证.