显微镜辅助下改良TLIF单侧入路双侧减压单侧内固定治疗腰椎管狭窄症的中远期疗效

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摘要目的探讨显微镜辅助下改良TLIF单侧入路双侧减压单侧内固定治疗腰椎管狭窄症的中远期临床疗效。方法 2010年8月至2018年2月采用显微镜辅助下改良经椎间孔腰椎椎间融合(transforaminal lumbar interbody fusion，TLIF)单侧入路双侧减压单侧内固定术治疗腰椎管狭窄症患者26例，男17例，女9例；年龄47~71岁，平均(61.5±6.28)岁。手术节段：L_3～4 4例，L_4～5 11例，L₅S₁9例，L_4～5、L₅S₁双节段2例。记录手术时间、术中出血量、术后引流量；采用疼痛视觉模拟评分法(visual analogue scale，VAS)评估患者腰痛和下肢疼痛程度，Oswestry功能障碍指数(Oswestry disability index，ODI)评估腰椎功能状况；测量手术前及术后随访时手术节段椎间隙高度及腰椎前凸角情况；末次随访时采用Bridwell标准评估椎间融合情况，采用MacNab标准评价患者临床疗效。结果所有患者随访时间25~98个月，平均(61.2±22.9)个月，手术时间平均(89.2±19.9)min，术中出血量平均(172.9±63.1)mL，术后引流量平均(93.0±27.2)mL。腰痛VAS评分、下肢痛VAS评分及ODI指数与术前相比明显降低，差异均有统计学意义(P<0.05)。术后手术节段椎间隙高度较术前明显增加，差异有统计学意义(P<0.05)；术后腰椎前凸角较术前有所增加，但差异无统计学意义(P＞0.05)。末次随访椎间融合按Bridwell标准Ⅰ级和Ⅱ级融合24例(92.3%)；优良率按MacNab标准评定，优19例，良5例，可2例，优良率为92.3%。1例患者出现脑脊液漏，给予加强换药后切口甲级愈合，无内固定物松动、断裂等并发症。结论显微镜辅助下改良TLIF单侧入路双侧减压单侧内固定治疗腰椎管狭窄症可取得满意的中远期临床疗效。

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关键词 ：经椎间孔腰椎椎体间融合术, 单侧入路, 双侧减压, 单侧固定, 腰椎管狭窄症

Abstract：Objective To investigate the medium-long-term clinical efficacy of modified transforaminal lumbar interbody fusion (TLIF) by unilateral approach with bilateral decompression and unilateral fixation assisted by microscope for the treatment of lumbar spinal stenosis.Methods We retrospectively analyzed 26 cases (17 males and 9 females) with lumbar spinal stenosis treated underwent modified transforaminal lumbar interbody fusion(TLIF) by unilateral approach with bilateral decompression and unilateral fixation assisted by microscope from August 2010 to February 2018.Their ages ranged from 47 to 71 years old，with a mean age of (61.5±6.28)years old.The operation level was L_3～4 in 4 cases，L_4～5 in 11 cases，L₅S₁ in 9 cases and L_4～5 and L₅S₁ in 2 cases.Clinical outcomes including operation duration，surgical blood loss，post-operative drainage volume and complications were recorded.Low back and lower limb pain were assessed using the visual analogue scale (VAS) and the Oswestry disability index(ODI) assessesed the functional condition of the lumbar spine.Average intervertebral height，lumbar Cobb angle were utilized to evaluate the reduction of intervertebral height and lumbar lordosis.At the last follow-up，Bridwell standard was used to evaluate the interbody fusion，and MacNab standard was used to evaluate the clinical efficacy of patients.Results All patients were followed up for 25 to 98 months，with an average of (61.2±22.9)months.The average operation time was (89.2±19.9)min and the average intraoperative blood loss was (172.9±63.1)mL.The average postoperative drainage volume was (93.0±27.2)mL.VAS score of low back pain，VAS score of lower limb pain and ODI index were significantly decreased compared with those before surgery，with statistical significance (P<0.05).The height of the intervertebral space of the operative segment was significantly increased after operation compared with that before operation，and the difference was statistically significant (P<0.05).The lordosis of lumbar spine was increased after surgery，but the difference was not statistically significant (P＞0.05).In the last follow-up，there were 24 cases (92.3%) of interbody fusion in accordance with Bridwell standard Ⅰ and Ⅱ.According to MacNab standard，19 cases were excellent，5 cases were good，and 2 cases were fair.The excellent and good rate was 92.3%.One patient had cerebrospinal fluid leakage，and the incision healed in grade A after intensive dressing change without any complications such as loosening or fracture of internal fixator.Conclusion The microscopeassisted modified TLIF unilateral approach with bilateral decompression and unilateral fixation can achieve satisfactory medium-long-term clinical effects in the treatment of lumbar spinal stenosis.

Key words： transforaminal lumbar interbody fusion unilateral approach bilateral decompression unilateral fixation lumbar spinal stenosis

通讯作者: 吴占勇

作者简介: 王会旺(1984— )，男，主治医师，冀中能源邢台矿业集团总医院骨科，054000。

引用本文:

王会旺，吴占勇*，吴华荣，马建青，徐伟坤，宁胜华，孙亚东，贾丁丁，杨克. 显微镜辅助下改良TLIF单侧入路双侧减压单侧内固定治疗腰椎管狭窄症的中远期疗效[J]. 实用骨科杂志, 2021, 27(6): 481-487.
Wang Huiwang，Wu Zhanyong*，Wu Huarong，et al. The Medium-Long-Term Effect of Microscope-Assisted Modified TLIF Unilateral Approach with Bilateral Decompression and Unilateral fixation for the Treatment of Lumbar Spinal Stenosis. sygkzz, 2021, 27(6): 481-487.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I6/481

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