摘要
目的:分析改良经皮经椎间孔腰椎椎体间融合术(modified percutaneous transforaminal lumbar inter-body fusion,MPTLIF)治疗腰椎退行性疾病的早期临床疗效.方法:回顾性分析2020年1月～2021年10月在陆军军医大学附属第二医院接受MPTLIF治疗的26例腰椎退行性疾病患者的临床资料,其中男性12例,女性14例;年龄44～77岁(58.3±8.4岁);腰椎滑脱症16例,腰椎不稳伴神经根管狭窄症10例;L3/4 3例,L4/5 23例.统计患者手术时间、术中出血量、术后住院时间和术后引流量,术前、术后3d、术后3个月和末次随访时进行疼痛视觉模拟评分(visual analogue scale,VAS),术前、术后3个月和末次随访时行Oswestry功能障碍指数(Oswestry disability index,ODI)评定,末次随访时采用改良MacNab疗效评定标准评价临床疗效.在术前和末次随访时的X线片和CT片上测量椎间隙前后缘高度、腰椎前凸角和手术节段前凸角.结果:所有患者均顺利完成手术,手术时间98.9±6.6min,术中出血量41.0±12.6mL,术后引流量38.1±9.5mL,术后平均住院时间3.8± 0.9d,无硬膜外血肿、感染或肌肉麻痹瘫痪等并发症.随访17.7±4.2个月,术前和术后3d、术后3个月和末次随访时的VAS评分分别为5.85±0.67分、2.15±0.54分、1.12±0.33分、0.54±0.51分,术前、术后3个月和末次随访时的ODI分别为(47.38±6.66)％、(11.73±6.73)％、(6.58±6.51)％,术后各时间点的VAS评分和ODI与术前比较均显著性改善(P＜0.05),且随着术后时间推移有进一步改善(P＜0.05);末次随访时改良MacNab疗效评定标准评定优24例,良2例.末次随访时椎间隙前后缘高度(前缘10.95±1.24mm、后缘9.45±1.13mm)、腰椎前凸角(47.38°±4.56°)和手术节段前凸角(8.62°±1.92°)均较术前(前缘 8.85±1.00mm、后缘 6.78±1.07mm、43.81 °±4.85°、6.62°±2.02°)有显著性改善(P＜0.05).结论:对严格适应证选择的病例,MPTLIF是一种安全、有效的微创治疗术式,治疗腰椎退行性疾病能够获得良好的早期临床疗效.
Abstract
Objectives:To analyze the early clinical efficacy of modified percutaneous transforaminal lumbar interbody fusion(MPTLIF)in the treatment of lumbar degenerative diseases.Methods:The clinical data of 26 patients who underwent MPTLIF at the Second Affiliated Hospital of Army Medical University between Jan-uary 2020 and October 2021 were analyzed retrospectively.There were 12 males and 14 females,aged 44-77 years(58.3±8.4 years);Lumbar spondylolisthesis in 16 cases,lumbar spinal instability with radicular stenosis in 10 cases;3 cases were of L3/4 and 23 cases were of L4/5.The operative time,intraoperative bleeding,post-operative hospital stay,and postoperative drainage were analyzed.The visual analogue scale(VAS)for pain was documented before operation,at 3d and 3 months after operation and at the final follow-up,the Oswestry disability index(ODI)was used for evaluation before operation,at 3 months and the final follow-up after oper-ation,and the modified MacNab efficacy evaluation criteria were used to evaluate the clinical efficacy at the final follow-up.The anteroposterior height of the intervertebral space,lumbar lordosis angle,and lordosis an-gle of the operated segment were measured on X-ray and CT images before surgery and at the final follow-up.Results:All the patients successfully underwent the operation with an operative time of 98.9±6.6min,in-traoperative bleeding of 41.0±12.6mL,postoperative drainage of 38.1±9.5mL,and an average postoperative hos-pital stay of 3.8±0.9d without complications such as epidural hematoma,infection,or muscle paralysis and paralysis.The follow-up time was 17.7±4.2 months,and the VAS scores preoperatively,3d postoperatively,3 months postoperatively,and at final follow-up were 5.85±0.67,2.15±0.54,1.12±0.33,0.54±0.51,respectively.The ODI were(47.38±6.66)％,(11.73±6.73)％,and(6.58±6.51)％before operation,at 3 months and the final follow-up,respectively.The VAS scores and ODI at all time points after operation significantly improved compared with the preoperative values(P＜0.05),and which improved over time(P＜0.05).At final follow-up,ac-cording to the modified MacNab criteria,24 cases were evaluated as excellent and 2 cases were evaluated as good.The anteroposterior height of the intervertebral space(anterior edge 10.95±1.24mm,posterior edge 9.45± 1.13mm),lumbar lordosis(47.38°±4.56°)and lordosis angle of the operated segment(8.62°±1.92°)were higher at final follow-up than before operation(anterior edge 8.85±1.00mm,posterior edge 6.78±1.07mm,43.81°±4.85°,6.62°±2.02°),with significant improvement(P＜0.05).Conclusions:MPTLIF is a safe and effective minimally invasive procedure for the treatment of lumbar degenerative disease in cases selected for strict indications,which can achieve great early clinical efficacy.
基金项目
陆军军医大学第二附属医院青年博士人才孵化计划(2022YQB020)
维普
万方数据