单切口双侧创TLIF在腰椎翻修手术中的临床研究.doc

单切口双侧微创TLIF在腰椎翻修手术中的临床研究 徐峰 蔡贤华 康辉 黄勇 （广州军区武汉总医院骨科 430070 武汉市） 徐峰：广州军区武汉总医院骨科副主任、脊柱外科病区主任 电话：， 邮编：430070 【摘要】目的 探讨单皮肤切口双侧肌间隙入路微创TLIF技术在腰椎翻修手术中的临床疗效 方法 本组共收治腰椎翻修患者24例，其中腰椎间盘突出症行腰椎间盘镜手术后8例、腰椎间盘突出症行单纯椎板开窗减压髓核摘除术后10例、腰椎管狭窄症后路椎板开窗减压术后6例。其中腰4/5节段13例、腰5骶1节段11例。均采用后正中皮肤切口双侧肌间隙入路，在Quadrant可扩张管道系统下行微创TLIF手术。采用视觉模拟评分系统（VAS）评估患者术前、术后两周、术后一年疼痛情况；应用ODI(Oswestry disability index)评分法进行临床效果评估。结果 随访时间14～26个月，平均16个月。所以病例均无脑脊液漏、无神经根损伤。术前VAS评分为7.8±0.3分，术后两周VAS评分为3.6±0.2分，术后一年VAS评分为2.8±0.1分；Oswestry指数术前平均80.8%，术后两周平均为23.2%，术后一年平均为20.3%。VAS评分和Oswestry指数术前与术后两周比较有统计学差异（P﹤0.05），术后两周与术后一年比较无统计学差异(P﹥0.05)。结论 单皮肤切口双侧肌间隙入路微创TLIF是腰椎翻修手术的一种有效方法，但要把握其适应证。 【关键词】微创；TLIF；翻修；腰椎 Clinical research of minimally invasive TLIF via single incision and bilateral muscle gap in lumbar revision surgery. Kang Hui，Cai Xianhua，Xu Feng，et al. 【Abstract】 Objective To analyze the effectiveness of minimally invasive TLIF Via single incision and Bilateral muscle gap in lumbar revision surgery. Method The clinic data of 24 patients with failed back surgery syndrome （8 primary surgical treatment with MED for LDH，10 primary surgical treatment by windowing of lamina and discectomy for LDH，6 primary surgical treatment by windowing of lamina for lumbar spinal stenosis）were reviewed and analyzed. A total of 24 segments were involved, including L4/5 in 13cases, L5S1 in 11cases. 24cases of failed back surgery syndrome were treated with minimally invasive TLIF via MAST Quadrant retractor using single incision and bilateral muscle gap.VAS score system was used to evaluate back pain the pre- and post operative (14d and 12 months ).The clinical outcomes were assessed by the Oswestry disability index. Results All patients were followed up for 14～26 months (mean, 16 months).There were no leakage of cerebrospinal fluid and nerve root injury during the operation.VAS score were 7.8±0.3 at preoperative, 3.6±0.2 at 14d postoperation, 2.8±0.1 at 12 months postoperation. Oswestry disability index was 80.8% at preoperative, 23.2% at