微創經椎間孔椎體間融合聯合單側椎弓根螺釘固定術治療椎間盤源性腰痛_《中國修復重建外科雜志》

作者：

梁博偉 ¹ , 趙勁民 ² , 李寧寧 ¹ , 胡朝暉 ¹ , 孫宏志 ¹

1廣西醫科大學第五附屬醫院 / 柳州市人民醫院脊柱外科（廣西柳州，545006）;;
2廣西醫科大學第一附屬醫院創傷手外科;

關鍵詞：

椎間盤源性腰痛經椎間孔椎體間融合術單側椎弓根螺釘固定術

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【摘要】目的 探討微創經椎間孔椎體間融合（transforaminal lumbar interbody fusion，TLIF）聯合單側椎弓根螺釘固定術（unilateral pedicle screw fixation，UPSF）治療椎間盤源性腰痛（discogenic low back pain，DLBP）的臨床療效。方法 2006年3月－2009年7月，采取微創TLIF聯合UPSF治療57例單節段DLBP患者。其中男27例，女30例；年齡38～61歲，平均45.6歲。病程9個月～11年。病變節段L2、 3 2例，L3、4 5例，L4、5 29例，L5、S1 21例。記錄手術時間、切口長度、術中出血量、術后引流量、住院時間、植骨融合率及手術并發癥。采用Oswestry功能障礙指數（ODI）及疼痛視覺模擬評分（VAS）評估臨床療效，并根據造影劑誘發一致性疼痛壓力大小及椎間盤封閉敏感性高低對患者手術療效進行分組比較。結果患者手術時間（84.6 ± 37.4）min，切口長度（3.4 ± 0.6）cm，術中出血量（132.5 ± 23.2）mL，術后引流量（58.7 ± 21.4）mL，住院時間（6.5 ± 0.8）d。患者均獲隨訪，隨訪時間2年2個月～5年4個月，平均3.2年。末次隨訪時ODI及VAS評分均較術前明顯改善（P lt; 0.05）；ODI評分改善率獲優27例，良22例，可6例，差2例，優良率為86.0%；均獲得堅強椎間融合。末次隨訪時，造影劑注射低壓力敏感組的ODI及VAS評分優于高壓力敏感組（P lt; 0.05）；椎間盤封閉高敏感組的ODI及VAS評分優于低敏感組（P lt; 0.05）。結論微創TLIF聯合UPSF治療DLBP手術創傷小，對腰椎后部結構破壞小，并發癥少，療效確切，但必須嚴格掌握手術適應證；造影劑注射低壓力敏感或椎間盤封閉高敏感患者手術療效較好。

引用本文： 梁博偉 ,趙勁民,李寧寧,胡朝暉,孫宏志. 微創經椎間孔椎體間融合聯合單側椎弓根螺釘固定術治療椎間盤源性腰痛. 中國修復重建外科雜志, 2012, 26(3): 272-276. doi: 復制

1.	腰椎疾患所致腰痛的臨床觀察. 中國脊柱脊髓雜志, 2010, 20(3): 224-227.
2.	剖學研究. 中國脊柱脊髓雜志, 2009, 19(10): 765-768.
3.	Zhang YG, Guo TM, Guo X, et al. Clinical diagnosis for discogenic low back pain. Int J Biol Sci, 2009, 5(7): 647-658. 2 Park WM, Mc Call IW, O’Brien JP, et al. Fissuring of the posterior annulus fibrosus in the lumbar spine. Br J Radiol, 1979, 52(617): 382-387.
4.	Errico TJ. Lumbar disc arthroplasty. Clin Orthop Relat Res, 2005, (435): 106-117.
5.	王建, 周躍, 李長青, 等. 經皮內鏡椎間盤切除術治療慢性椎間盤源性腰痛的初步研究. 中國修復重建外科雜志, 2009, 23(4): 400-403.
6.	Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology, 1988, 168(1): 177-186.
7.	李兵, 胡朝暉, 卓祥龍. 經椎間孔椎體間融合治療退行性腰椎間盤病. 中國修復重建外科雜志, 2008, 22(8): 914-917.
8.	Schulte TL, Leistra F, Bullmann V, et al. Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360 degrees fusion. Eur Spine, 2007, 16(2): 2152-2158.
9.	Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw xation as an adjunct to posterolateral fusion for low-back pain. J Neurosurg Spine, 2005, 2(6): 700-706.
10.	Ohtori S, Koshi T, Yamashita M, et al. Surgical versus nonsurgical treatment of selected patients with discogenic low back pain: a small-sized randomized trial. Spine (Phila Pa 1976), 2011, 36(5): 347-354.
11.	O’Neill C, Kurgansky M. Subgroups of positive discs on discography. Spine (Phila Pa 1976), 2004, 29(19): 2134-2139.
12.	Kallewaard JW, Terheggen MA, Groen GJ, et al. Discogenic low back pain. Pain Pract, 2010, 10(6): 560-579.
13.	Kotil K, Tunckale T, Tatar Z, et al. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine, 2007, 6(2): 121-125.
14.	Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
15.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
16.	Fan S, Hu Z, Zhao F, et al. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J, 2010, 19(2): 316-324.
17.	Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
18.	董健文, 邱奕雁, 趙衛東, 等. 單側椎弓根釘棒固定單節段腰椎及其鄰近節段生物力學研究. 中國臨床解剖學雜志, 2010, 28(1): 85-89.
19.	Kepler CK, Sharma AK, Huang RC. Lateral transpsoas interbody fusion (LTIF) with plate fixation and unilateral pedicle screws: a preliminary report. J Spinal Disord Tech, 2011, 24(6): 363-367.
20.	劉濤, 李長青, 周躍, 等. 微創單側椎弓根螺釘固定、椎體間融合治療.
21.	王建華, 夏虹, 李樹林, 等. 微創經椎間孔腰椎椎間融合術的應用解.

1. 腰椎疾患所致腰痛的臨床觀察. 中國脊柱脊髓雜志, 2010, 20(3): 224-227.
2. 剖學研究. 中國脊柱脊髓雜志, 2009, 19(10): 765-768.
3. Zhang YG, Guo TM, Guo X, et al. Clinical diagnosis for discogenic low back pain. Int J Biol Sci, 2009, 5(7): 647-658. 2 Park WM, Mc Call IW, O’Brien JP, et al. Fissuring of the posterior annulus fibrosus in the lumbar spine. Br J Radiol, 1979, 52(617): 382-387.
4. Errico TJ. Lumbar disc arthroplasty. Clin Orthop Relat Res, 2005, (435): 106-117.
5. 王建, 周躍, 李長青, 等. 經皮內鏡椎間盤切除術治療慢性椎間盤源性腰痛的初步研究. 中國修復重建外科雜志, 2009, 23(4): 400-403.
6. Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology, 1988, 168(1): 177-186.
7. 李兵, 胡朝暉, 卓祥龍. 經椎間孔椎體間融合治療退行性腰椎間盤病. 中國修復重建外科雜志, 2008, 22(8): 914-917.
8. Schulte TL, Leistra F, Bullmann V, et al. Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360 degrees fusion. Eur Spine, 2007, 16(2): 2152-2158.
9. Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw xation as an adjunct to posterolateral fusion for low-back pain. J Neurosurg Spine, 2005, 2(6): 700-706.
10. Ohtori S, Koshi T, Yamashita M, et al. Surgical versus nonsurgical treatment of selected patients with discogenic low back pain: a small-sized randomized trial. Spine (Phila Pa 1976), 2011, 36(5): 347-354.
11. O’Neill C, Kurgansky M. Subgroups of positive discs on discography. Spine (Phila Pa 1976), 2004, 29(19): 2134-2139.
12. Kallewaard JW, Terheggen MA, Groen GJ, et al. Discogenic low back pain. Pain Pract, 2010, 10(6): 560-579.
13. Kotil K, Tunckale T, Tatar Z, et al. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine, 2007, 6(2): 121-125.
14. Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
15. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
16. Fan S, Hu Z, Zhao F, et al. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J, 2010, 19(2): 316-324.
17. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
18. 董健文, 邱奕雁, 趙衛東, 等. 單側椎弓根釘棒固定單節段腰椎及其鄰近節段生物力學研究. 中國臨床解剖學雜志, 2010, 28(1): 85-89.
19. Kepler CK, Sharma AK, Huang RC. Lateral transpsoas interbody fusion (LTIF) with plate fixation and unilateral pedicle screws: a preliminary report. J Spinal Disord Tech, 2011, 24(6): 363-367.
20. 劉濤, 李長青, 周躍, 等. 微創單側椎弓根螺釘固定、椎體間融合治療.
21. 王建華, 夏虹, 李樹林, 等. 微創經椎間孔腰椎椎間融合術的應用解.

《中國修復重建外科雜志》

微創經椎間孔椎體間融合聯合單側椎弓根螺釘固定術治療椎間盤源性腰痛

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《中國修復重建外科雜志》

微創經椎間孔椎體間融合聯合單側椎弓根螺釘固定術治療椎間盤源性腰痛

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