极外侧入路腰椎椎间融合术与传统后路术式治疗高位腰椎间盘突出症的病例对照研究

目的 :比较极外侧入路腰椎椎间融合术(extreme lateral interbody fusion,XLIF)与传统后路手术治疗高位腰椎间盘突出症的临床疗效。方法:收集2010年6月至2014年12月高位腰椎间盘突出症60例患者的临床资料,其中极外侧入路椎间植骨椎体钉固定组(XLIF组)30例,其中T_(12)L_12例、L_(1,2)6例、L_(2,3)10例、L_(3,4)12例;后入路椎间植骨椎弓根钉固定组(传统后路组)30例,其中T_(12)L_11例、L_(1,2)6例、L_(2,3)8例、L_(3,4)15例。记录手术切口长度、手术时间、术中出血量、术后引流液量、住院时间,比较手术前后腰痛视觉模拟评分(visual analogue score,VAS)和腰椎日本骨科协会(Japanese Orthopedic Association,JOA)评分(29分法),并根据影像资料,观察椎间融合器有无移位,分析椎间融合率情况。结果:所有患者获得随访,时间12~48个月,平均29个月。XLIF组术后股神经损伤2例,术后3个月内恢复;传统后路组切口浅表感染1例,予抗感染治疗后治愈。术中、术后均未出现脑脊液漏、马尾损伤以及下肢神经根功能恶化现象。XLIF组手术时间(65.6±20.5)min,术中出血量(48.8±15.3)ml,术后引流量0 ml;传统后路组手术时间(135.2±33.9)min,术中出血量(260.3±125.7)ml,术后引流量(207.1±50.2)ml;XLIF手术时间短于传统后路组,术中出血量、术后引流量也较传统后路组少(P0.05)。两组随访时的JOA、VAS评分均较术前明显改善(P0.05),但术后1、6、24个月VAS、JOA评分两组对比差异无统计学意义(P0.05)。两组术后6、12个月随访的融合率比较差异无统计学意义(P0.05)。结论 :应用XLIF治疗高位腰椎间盘突出症具有微创、手术时间短、并发症少、术后融合率高的优点,具有更好的临床疗效。

Case-control study of therapeutic effects between extreme lateral interbody fusion and conventional posterior operation for the treatment of upper lumbar disc herniation

Objective: To evaluate the clinical outcomes between extreme lateral interbody fusion and conventional posterior operation in the treatment of upper lumbar disc herniation.Methods: Among 60 patients with upper lumbar disc herniation were treated with extreme lateral interbody fusion(XLIF) or conventional posterior operation from June 2010 to December 2014,30 patients(19 males and 11 females) were treated with XLIF (XLIF group);and the other 30 patients(17 males and 13 females) were treated with conventional posterior operation (conventional group). In XLIF group,the lesions occurred at T₁₂L₁ segments in 2 patients,at L_1,2 segments in 6 patients,at L_2,3 segments in 10 patients,and at L_3,4 segment in 12 patients. In conventional group,the lesions occurred at T₁₂L₁ segments in 1 patient,at L_1,2 segments in 6 patients,at L_2,3 segments in 8 patients,and at L_3,4 segment in 15 patients. Operative incision lengths,time,blood loss,postoperative draining volume,hospital stays were recorded. Pre-and post-operative visual analogue score(VAS) and Japanese Orthopedic Association(JOA) were compared between two groups. According to the image data,the intervertebral fusion device was observed to be displaced and the rate of interbody fusion was analyzed.Results: All the patients were followed up,and the duration ranged from 12 to 48 months,with an average of 29 months. The complications included 2 femoral nerve damage in XLIF group (postoperative recovery within 3 months) and superficial incision infection in conventional group(cured by anti-infection). There were no patients with cerebrospinal fluid leakage(CSFL),cauda equina injuries or functional deterioration in the nerve root of lower limbs. In the XLIF group:the operative time was (65.6±20.5) minutes,blood loss was (48.8±15.3) ml,postoperative draining volume was 0 ml. In the conventional group:the operative time was (135.2±33.9) minutes,blood loss was (260.3±125.7) ml,postoperative draining volume was (207.1±50.2) ml. The operative time,blood loss,postoperative draining volume in XLIF group were less than those in the conventional group(P<0.05). The JOA and VAS score were significantly improved in both groups during the follow-up period compared with those before operation(P<0.05). But the difference of the JOA and VAS score between the two groups 1,6,and 24 months after surgery had not significant differences(P>0.05). There were no significant differences in the fusion rate between the two groups 6 and 12 months after operation(P>0.05).Conclusion: The XLIF fusion for the treatment of upper lumbar disc herniation has several advantages such as minimal invasive,stable vertebral plate,less complications and postoperative fusion rate,which has a better clinical effect.