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摘要 目的 比较微创通道下经单侧入路双侧减压(microsurgical bilateral decompression via a unilateral approach,MBDU)+经椎间孔椎间植骨融合术(minimally invasive surgery-transforaminal lumbar interbody fusion,MIS-TLIF)与传统后路开放减压+经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性疾病的疗效。方法 回顾性分析2014年10月至2015年9月西安交通大学医学院附属红会医院脊柱外科行手术治疗且获得完整随访的的单节段或双节段腰椎退行性疾病患者100例。其中采用开放减压+TLIF(TLIF组)手术治疗52例,行MBDU+MIS-TLIF(MBDU组)48例。记录手术时间、术中出血量、术后引流量、住院时间,术前1d及术后1、 3、5 d血清肌酸激酶(creatine kinase,CK)水平,所有患者均于术前、术后1、3、12个月及随访时进行视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)评分和影像学检查。结果 所有患者均获得随访,随访时间18~24个月,平均20.2个月。两组患者一般资料、术前CK水平、腰腿痛VAS评分、ODI评分、手术时间、并发症发生率比较差异无统计学意义(P>0.05);术中出血量、术后引流量、住院时间及术后1、3、5 d的血清CK水平MBDU组均明显偏低(P<0.01);术后3、12个月腰痛VAS及ODI评分MBDU组均较低(P<0.05);而3、12个月腿痛VAS评分,两组比较差异无统计学意义(P>0.05)。结论 MBDU+MIS-TLIF治疗腰椎退行性疾病可取得不次于传统开放手术的的疗效,且手术创伤较小、恢复较快。
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关键词 :
腰椎退行性疾病,
单侧入路双侧减压,
经椎间孔椎间植骨融合术,
经椎间孔椎体间融合术
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基金资助:国家自然科学基金资助项目(81601938)
陕西省自然科学基金项目(2016JQ8010)
西安市科技计划项目[2016050SF/YX06(6)] |
作者简介: 胡慧敏(1981- ),男,副主任医师,西安交通大学医学院附属红会医院脊柱外科,710054。 |
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