微创经椎间孔椎体间融合联合单侧椎弓根螺钉固定术治疗椎间盘源性腰痛VIP免费

ChineseJournalofReparativeandReconstructiveSurgery,March2012,Vol.26,No.3·272·作者单位：1广西医科大学第五附属医院/柳州市人民医院脊柱外科（广西柳州，545006）；2广西医科大学第一附属医院创伤手外科通讯作者：李宁宁，教授，硕士生导师，研究方向：脊柱外科，E-mail:gllnn@tom.com网络出版时间：2012-2-2908:59；网络出版地址：http://www.cnki.net/kcms/detail/51.1372.R.20120229.0859.004.html微创经椎间孔椎体间融合联合单侧椎弓根螺钉固定术治疗椎间盘源性腰痛梁博伟1赵劲民2李宁宁1胡朝晖1孙宏志1【摘要】目的探讨微创经椎间孔椎体间融合（transforaminallumbarinterbodyfusion，TLIF）联合单侧椎弓根螺钉固定术（unilateralpediclescrewfixation，UPSF）治疗椎间盘源性腰痛（discogeniclowbackpain，DLBP）的临床疗效。方法2006年3月－2009年7月，采取微创TLIF联合UPSF治疗57例单节段DLBP患者。其中男27例，女30例；年龄38～61岁，平均45.6岁。病程9个月～11年。病变节段L2、32例，L3、45例，L4、529例，L5、S121例。记录手术时间、切口长度、术中出血量、术后引流量、住院时间、植骨融合率及手术并发症。采用Oswestry功能障碍指数（ODI）及疼痛视觉模拟评分（VAS）评估临床疗效，并根据造影剂诱发一致性疼痛压力大小及椎间盘封闭敏感性高低对患者手术疗效进行分组比较。结果患者手术时间（84.6±37.4）min，切口长度（3.4±0.6）cm，术中出血量（132.5±23.2）mL，术后引流量（58.7±21.4）mL，住院时间（6.5±0.8）d。患者均获随访，随访时间2年2个月～5年4个月，平均3.2年。末次随访时ODI及VAS评分均较术前明显改善（P<0.05）；ODI评分改善率获优27例，良22例，可6例，差2例，优良率为86.0%；均获得坚强椎间融合。末次随访时，造影剂注射低压力敏感组的ODI及VAS评分优于高压力敏感组（P<0.05）；椎间盘封闭高敏感组的ODI及VAS评分优于低敏感组（P<0.05）。结论微创TLIF联合UPSF治疗DLBP手术创伤小，对腰椎后部结构破坏小，并发症少，疗效确切，但必须严格掌握手术适应证；造影剂注射低压力敏感或椎间盘封闭高敏感患者手术疗效较好。【关键词】椎间盘源性腰痛经椎间孔椎体间融合术单侧椎弓根螺钉固定术SURGICALTREATMENTOFDISCOGENICLOWBACKPAINBYMINIMALLYINVASIVETRANSFORAMINALLUMBARINTERBODYFUSIONCOMBINEDWITHUNILATERALPEDICLESCREWFIXATION/LIANGBowei1,ZHAOJinmin2,LINingning1,HUZhaohui1,SUNHongzhi1.1DepartmentofSpineSurgery,theFifthAffiliatedHospitalofGuangxiMedicalUniversity/LiuzhouPeople’sHospital,LiuzhouGuangxi,545006,P.R.China;2DepartmentofHandSurgery,theFirstAffiliatedHospitalofGuangxiMedicalUniversity.Correspondingauthor:LINingning,E-mail:gllnn@tom.com【Abstract】ObjectiveToinvestigatetheeffectivenessofsurgicaltreatmentfordiscogeniclowbackpain(DLBP)byminimallyinvasivetransforaminallumbarinterbodyfusion(TLIF)combinedwithunilateralpediclescrewfixation(UPSF).MethodsBetweenMarch2006andJuly2009,57patientswithsingle-levelDLBPweretreatedbyminimallyinvasiveTLIFcombinedwithUPSF,including27malesand30femaleswithanaverageageof45.6years(range,38-61years)andadiseasedurationof3.8years(range,9monthsto11years).TheinvolvedsegmentsincludedL2，3in2cases,L3，4in5cases,L4，5in29cases,andL5,S1in21cases.Theoperativetime,incisionlength,intraoperativebloodloss,postoperativedrainagevolume,hospitalizationtimes,fusionrate,andcomplicationswereobserved.TheeffectivenesswereevaluatedthroughOswestrydisabilityindex(ODI)andvisualanaloguescore(VAS),andtheoperativeoutcomeswerecomparedindifferentgroupsclassifiedaccordingtovariouspressuresofthecontrastmediumandsensitivitiestodiscoblockafterinducingconsistentpain.ResultsTheoperationtime,incisionlength,bloodloss,postoperativedrainagevolume,andhospitalizationtimeswere(84.6±37.4)minutes,(3.4±0.6)cm,(132....