自制微创拉钩辅助改良双侧Wiltse入路经椎间孔椎体间融合术在腰椎退行性病变治疗中的应用

目的:探讨自制微创拉钩辅助改良双侧Wiltse入路经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)在治疗腰椎退行性病变中的优势。方法:回顾性分析2016年10月至2017年10月行腰椎融合手术的140例患者的临床资料,其中72例患者采用自制微创拉钩辅助改良双侧Wiltse入路TLIF治疗(A组),男37例,女35例,年龄(48±16)岁;68例采用传统后正中入路TLIF治疗(B组),男38例,女30例,年龄(45±15)岁。记录两组患者的手术切口大小、手术时间、术中出血量、术后引流量、术后伤口愈合情况及末次随访椎间融合率,并采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)对两组患者的临床疗效进行评定。结果:所有患者获得随访,时间3~13(8±5)个月。A组患者术后伤口愈合良好,B组术后发生伤口坏死1例,经清创缝合后痊愈。两种手术方式在手术时间、术后融合率方面差异无统计学意义(P>0.05);A组在手术切口大小、术中出血量、术后引流量方面有明显优势(P<0.05),且术后的腰腿痛VAS评分及ODI均优于B组(P<0.05)。结论:自制微创拉钩辅助改良双侧Wiltse入路TLIF在治疗腰椎退行性病变中具有微创、术中出血量少、术后引流少、并发症少、融合稳定等特点。

Clinical application of self-made minimally invasive hood-assisted transforaminal lumbar interbody fusion via modified bilateral Wiltse approach in the treatment of lumbar degenerative diseases

Objective: To explore the advantages of self-made minimally invasive hook-assisted transforaminal lumbar interbody fusion (TLIF) via modified bilateral Wiltse approach in the treatment of lumbar degenerative diseases. Methods: The clinical data of 140 patients underwent lumbar spine fusion surgery from October 2016 to October 2017 were retrospectively analyzed. Among them,72 cases were treated by self-made minimally invasive hook-assisted TLIF via modified bilateral Wiltse approach (group A),there were 37 males and 35 females,aged (48±16) years old;68 cases were treated by TLIF via traditional posterior median approach (group B),there were 38 males and 30 females,aged (45±15) years old. The surgical incision size,operation time,intraoperative blood loss volume,postoperative drainage volume,postoperative wound healing,and intervertebral fusion rate at the final follow-up were recorded between two groups. Visual analogue scale(VAS) and Oswestry Disability Index(ODI) were used to assess the clinical efficacy. Results: All the patients were followed up for 3 to 13(8±5) months. The wound in group A healed well after operation,and 1 case in group B occurred wound necrosis after operation,and healed after debridement and suture. There were no significant differences in operation time and postoperative fusion rate between two surgical methods(P>0.05). Group A had obvious advantages in surgical incision size,intraoperative blood loss volume and postoperative drainage volume(P<0.05),and the postoperative VAS score of low back pain and ODI were better than group B(P<0.05). Conclusion: The self-made minimally invasive hook-assisted TLIF via modified bilateral Wiltse approach has the characteristics of minimally invasive,less intraoperative blood loss,less postoperative drainage,fewer complications,and more stable fusion in the treatment of lumbar degenerative desease.