微创腰椎经椎间孔椎体间融合术的并发症分析：131例病例回顾和文献复习

背景：微创腰椎经椎间孔入路椎间融合（MIS-TLIF）被广泛应用于腰椎退变的手术治疗并取得了良好的临床效果，但微创手术可能增加并发症的风险。目的：总结MIS-TLIF的发生，并探讨并发症的发生原因和相关对策。方法：对2010年1月至2011年5月间行MIS-TLIF手术的连续131例病例进行回顾分析。记录患者的手术时间，术中出血量，术后住院时间，并发症情况。并在术前、术后3个月以及末次随访时以VAS评分评估患者手术前后腰痛的程度，以Oswestry伤残指数和JOA评分评估患者的功能。结果：平均随访8．3个月；所有患者平均手术时间为（146．4±36．9）min，平均术中出血（176．7±86．1）ml，术后平均住院时间为（4．4±1．6）d；患者术后3个月及最后随访时腰痛及功能状况均较术前有明显的改善；16人次（12．2％）出现并发症：伤口局部血肿1例（0．8％）；硬膜撕裂6例（4．6％）；椎弓根螺钉位置欠佳6枚（1．0％）；1例不明原因足下垂（0．8％）；1例79岁患者术后出现肺部感染（0．8％）；1例76岁患者术后出现尿潴留（0．8％）。结论：微创腰椎经椎间孔椎体问融合术治疗腰椎退变性疾病安全、可靠，并发症的发生主要与MIS-TLIF的手术特点、学习曲线及患者的选择有关，应重视MIS-TLIF手术技术的培训，严格掌握适应证，以减少相关并发症的发生。只要进行严格的筛选和术前准备，老年患者也可进行微创手术的治疗。

Perioperative complications of minimally invasive transforaminal lumbar interbody fusion:retrospective study for 131 cases and literature review

Background:Though minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)has been widely used in the surgical treatment of lumbar degenerative disease with satisfactory results,it may have more complications. Objective:The purpose of the present study is to evaluate the incidence of the complications of MIS-TLIF and to investigate its reasons and prevention. Methods:A retrospective analysis was performed on 131 consecutive cases of minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF)from January 2010 to May 2011.The operation time,intra-operative blood loss,post-operative hospitalization and the peri-operative complications were recorded.The visual analog scale(VAS)for back pain,Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score for functional evaluation were recorded preoperatively, 3 months postoperatively and at the final follow-up. Results:Mean follow-up duration was 8.3 months.Average operation time was(146.4±36.9)min,average intra-operative blood loss was(176.7±86.1)ml and average post-operative hospital stay was(4.4±1.6)d.The VAS for back pain,ODI and JOA score were all significantly improved after surgery and at the final follow-up.Complications happened in 16 patients:1 case with post-operative hematoma;6 cases of dura tearing(4.6%)without CSF leakage,with a higher risk for cases of bilateraldecompression via unilateral approach(P=0.012);6 cases of screw malposition;1 case of drop foot for unknown causes;1 case of pulmonary infection and 1 case of urinary retention for elderly patient. Conclusions:MIS-TLIF in the treatment of lumbar degenerative disc disease is safe and effective.The incidence of complications is low and correlated more with the feature of the technique,the learning curve and the patient selection.Surgical technique training and patient selection are critical for the prevention of peri-operative complications.If selected properly,elderly patients are not contra-indication for MIS-TLIF.