Wiltse入路单侧椎弓根螺钉联合椎间孔椎体融合术治疗极外侧型腰椎间盘突出症的临床效果(1)
[摘要]目的 探討Wiltse入路单侧椎弓根螺钉联合椎间孔椎体融合术(TLIF)治疗极外侧型腰椎间盘突出症(FLLDH)的临床效果。方法 回顾性分析2009年1月～2013年12月我院收治的60例FLLDH患者的临床资料，其中采用Wiltse入路单侧TLIF治疗的患者作为单侧TLIF组(30例)，采用后路腰椎椎体间融合术(PLIF)治疗的患者作为PLIF组(30例)。比较两组患者的手术时间、术中出血量、术后引流量、术后住院时间、术后并发症发生情况等，采用视觉模拟量表(VAS)评估患者的疼痛情况，采用Oswestry功能障碍指数(ODI)评价疗效，通过影像学评估椎间融合、多裂肌萎缩及邻近节段退变(ASD)情况。所有患者均获5年随访。结果 单侧TLIF组的手术时间、术后住院时间均短于PLIF组，术中出血量、术后引流量均少于PLIF组，差异有统计学意义(P<0.05)。两组患者术后5 d、5年的VAS评分和ODI指数均低于术前，差异有统计学意义(P<0.05);单侧TLIF组术后5 d、术后5年的VAS评分和ODI指数均低于PLIF组，差异有统计学意义(P<0.05)。两组的椎间融合率比较，差异无统计学意义(P>0.05)。单侧TLIF组的多裂肌萎缩率及ASD发生率均低于PLIF组，差异有统计学意义(P<0.05)。结论 两种手术方式治疗FLLDH的椎间融合率相近，但Wiltse入路单侧TLIF创伤更小，可有效降低ASD的风险，改善术后腰背部疼痛。
[关键词]极外侧型腰椎间盘突出症;经椎间孔椎体间融合;单侧;肌间隙入路
[中图分类号] R681.5+5 [文献标识码] A [文章编号] 1674-4721(2019)7(a)-0012-05
[Abstract] Objective To investigate the clinical effect of unilateral pediele screw fixation combined with transforaminal lumbar interbody fusion (TLIF) in the treatment of far lateral lumbar disc herniation (FLLDH) through Wiltse approach. Methods The clinical data of 60 patients with FLLDH treated by surgery from January 2009 to December 2013 in our hospital were retrospectively analyzed. Among them， 30 patients who underwent unilateral pediele screw fixation combined with TLIF through Wiltse approach were regarded as the unilateral TLIF group， another 30 patients who experienced posterior lumbar interbody fusion (PLIF) were taken as the PLIF group. The operation time， blood loss volume of operation， blood loss volume of postoperation， hospitalization time of postoperation and postoperation complication were compared between the two groups. Visual analogue scale (VAS) was used to evaluate pain， Oswestry dysfunction index (ODI) was used to evaluate efficacy， and radiological examination was obtained for each patient to assess the postoperative intervertebral fusion conditions， shrink rates of multifidus and adjacent segment disease (ASD). All patients were followed up for an average of 5 years. Results The operation time， hospitalization time of postoperation in the unilateral TLIF group were significantly shorter than those in the PLIF group， the blood loss volume of operation， blood loss volume of postoperation in the unilateral TLIF group were significantly less than those in the PLIF group， with statistically significant differences (P<0.05). The score of VAS and ODI at 5 day， 5 year postoperatively were lower when compared with preoperative values in the two groups， with statistically significant differences (P<0.05). The score of VAS and ODI in the unilateral TLIF group were significantly lower than those in the PLIF group at 5 day， 5 year postoperatively， with statistically significant differences (P<0.05). There was no significant difference in the rate of intervertebral fusion between the two groups (P>0.05). The shrink rates of multifidus and the incidence rate of ASD in the unilateral TLIF group were lower than those in the PLIF group， with statistically significant differences (P<0.05). Conclusion The intervertebral fusion rate in both the unilateral TLIF group and the PLIF group is similar for FLLDH， but unilateral TLIF through Wiltse approach has advantage in reducing trauma， improving postoperative back pain and preventing ASD., http://www.100md.com(邓立明 王建波 黄凯)
[关键词]极外侧型腰椎间盘突出症;经椎间孔椎体间融合;单侧;肌间隙入路
[中图分类号] R681.5+5 [文献标识码] A [文章编号] 1674-4721(2019)7(a)-0012-05
[Abstract] Objective To investigate the clinical effect of unilateral pediele screw fixation combined with transforaminal lumbar interbody fusion (TLIF) in the treatment of far lateral lumbar disc herniation (FLLDH) through Wiltse approach. Methods The clinical data of 60 patients with FLLDH treated by surgery from January 2009 to December 2013 in our hospital were retrospectively analyzed. Among them， 30 patients who underwent unilateral pediele screw fixation combined with TLIF through Wiltse approach were regarded as the unilateral TLIF group， another 30 patients who experienced posterior lumbar interbody fusion (PLIF) were taken as the PLIF group. The operation time， blood loss volume of operation， blood loss volume of postoperation， hospitalization time of postoperation and postoperation complication were compared between the two groups. Visual analogue scale (VAS) was used to evaluate pain， Oswestry dysfunction index (ODI) was used to evaluate efficacy， and radiological examination was obtained for each patient to assess the postoperative intervertebral fusion conditions， shrink rates of multifidus and adjacent segment disease (ASD). All patients were followed up for an average of 5 years. Results The operation time， hospitalization time of postoperation in the unilateral TLIF group were significantly shorter than those in the PLIF group， the blood loss volume of operation， blood loss volume of postoperation in the unilateral TLIF group were significantly less than those in the PLIF group， with statistically significant differences (P<0.05). The score of VAS and ODI at 5 day， 5 year postoperatively were lower when compared with preoperative values in the two groups， with statistically significant differences (P<0.05). The score of VAS and ODI in the unilateral TLIF group were significantly lower than those in the PLIF group at 5 day， 5 year postoperatively， with statistically significant differences (P<0.05). There was no significant difference in the rate of intervertebral fusion between the two groups (P>0.05). The shrink rates of multifidus and the incidence rate of ASD in the unilateral TLIF group were lower than those in the PLIF group， with statistically significant differences (P<0.05). Conclusion The intervertebral fusion rate in both the unilateral TLIF group and the PLIF group is similar for FLLDH， but unilateral TLIF through Wiltse approach has advantage in reducing trauma， improving postoperative back pain and preventing ASD., http://www.100md.com(邓立明 王建波 黄凯)