改良微创经椎间孔腰椎体间融合术的可行性研究

目的 探讨单侧微创经椎间孔腰椎体间融合术（minimally invasive transforaminal lumbar interbody fusion,MISTLIF）采用单侧椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定治疗单节段腰椎退行性疾病术后不放置引流管的可行性.方法 回顾性分析2009年1月～2011年6月55例单节段腰椎退行性疾病的临床资料,前24例（A组）采用双侧切口行MISTLIF手术,双侧置入椎弓根螺钉,并放置引流管;后31例（B组）采用单侧切口置入单侧椎弓根螺钉和对侧经椎板关节突螺钉,不放置引流管.比较2组术中出血量等指标及引流管相关并发症发生情况.结果 A组术中出血量（92.2 ±25.1）ml,术后引流量（44.1±21.0）ml,引流管放置时间（1.1±0.2）d;B组术中出血量（56.3±22.8） ml,明显少于A组（t=5.543,P=0.000）.2组术后3天超声或MRI均未见手术部位血肿或积液.2组伤口感染、血肿压迫等并发症发生情况无统计学差异（P＞0.05）.B组术后1天腰痛视觉模拟评分（visual analogue scale,VAS）优于A组（t=2.204,P=0.032）,术后下地时间和住院时间均短于A组（t=9.368,P=0.000;t=9.541,P=0.000）.结论 单节段腰椎MIS-TLIF采用椎弓根螺钉结合经椎板关节突螺钉的双侧混合内固定术后不放置引流管是可行的.

A Feasibility Research of Modified Minimally Invasive Transforaminal Lumbar Interbody Fusion

Objective To investigate the feasibility and safety of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） using pedicle screws and a translaminar screw for single-level lumbar disc disease without drainage tube.Methods A retrospective analysis was conducted on 55 patients with single-level disc disease undergoing MIS-TLIF in our hospital from January 2009 to June 2011.The 55 patients were divided into two groups：24 cases used bilateral pedicle screw fixation with drainage tube （group A） and 31 cases used unilateral incision pedical screws and a translaminar facet screw hybrid fixation without drainage tube （group B）.The intraoperative blood loss,the operative complications and the perioperative parameters were compared.Results The average operative blood loss was （92.2 ± 25.1） ml,postoperative drainage was （44.1 ± 21.0） ml and intubation time was （1.1 ± 0.2） d in group A.The average operative blood loss was （56.3 ± 22.8） ml in group B,significantly less than that of group A （t =5.543,P =0.000）.Ultrasonography or MRI on the third postoperative day showed there was no hematoma or hydrops at the operative site in the two groups.The statistical difference was not found in the incidence rate of complications between the two groups （P ＞ 0.05）.The back pain VAS score of group B in the first postoperative day was lower than group A （t =2.204,P =0.032）,and there were shorter bedridden time and hospital stay in group B （t =9.368,P =0.000; t =9.541,P =0.000）.Conclusion Intubation is not necessary in single-level MIS-TLIF using pedicle screw and a contralateral translaminar screw bilateral hybrid fixation.