| 经皮脊柱内镜辅助下腰椎椎体间融合术及其临床应用 |
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投稿时间：2019-07-22
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| 作者 | Author | 单位 | Address | E-Mail |
| 张骏 |
ZHANG Jun |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
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| 金梦然 |
JIN Meng-ran |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
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| 赵廷潇 |
ZHAO Ting-xiao |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
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| 邵海宇 |
SHAO Hai-yu |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
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| 刘建文 |
LIU Jian-wen |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
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| 陈锦平 |
CHEN Jin-ping |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
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| 陈炘佶 |
CHEN Xin-ji |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
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| 黄亚增 |
HUANG Ya-zeng |
浙江省人民医院骨科, 浙江 杭州 310014 |
Depatrment of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang, China |
huangyazeng2007@163.com |
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| 期刊信息：《中国骨伤》2019年，第32卷，第12期，第1138-1143页 |
| DOI：10.3969/j.issn.1003-0034.2019.12.014 |
| 基金项目: |
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中文摘要:
目的：总结经皮脊柱内镜辅助下腰椎椎体间融合术的技术要点，评价并探讨该术式在治疗腰椎退变性疾病中的安全性及近期疗效。
方法：回顾性分析2017年10月至2018年4月24例采用经皮脊柱内镜辅助下腰椎椎体间融合术联合后路经皮椎弓根钉棒内固定治疗下腰椎病变的患者资料。其中，男16例，女8例；年龄39~72（59.6±9.5）岁；腰椎间盘突出伴椎间隙退变15例，腰椎轻度滑脱伴或不伴节段性不稳定9例；22例为单节段融合，2例为双节段融合；单节段融合的节段L2，3 1例，L3，4 3例，L4，5 18例，2例双节段融合均为L3，4及L4，5。该技术主要包括局麻加基础麻醉下，行穿刺及椎间孔镜下减压、椎间隙处理及取自体骨植入、融合器植入并撑开，以及后路经皮椎弓根螺钉内固定术。临床疗效评价采用视觉疼痛评分（visual analogue scale，VAS），Oswestry功能障碍指数（Oswestry disability index，ODI），记录手术时间、术中出血量、术中及术后并发症等。所有患者于术前，术后3 d及1、3、6、12、18个月摄腰椎正侧位X线片，行CT平扫及三维重建、MRI检查评估内植入物稳定性及融合情况。
结果：所有患者获得随访，时间12~18个月。单节段融合手术时间（192.3±22.7）min，双节段融合（272.5±24.7）min。估计术中出血量每节段<50 ml，所有患者未输血。术前VAS（7.4±1.1）分，术后改善至（2.3±0.8）分（t=-19.65，P<0.000 5）；术前ODI（41.2±3.3）%，末次随访时改善为（12.3±2.5）%（t=-35.76，P<0.000 5）。术后共出现手术相关并发症4例，2例术后出现对侧神经根性症状，于对侧椎间孔镜减压治疗后，症状完全缓解；1例出现经皮螺钉置入相关神经症状，予拆除该侧钉棒内固定后，症状缓解；1例出现手术切口感染，予清创缝合术后好转。至末次随访，所有患者未出现融合器及钉棒系统的移位和松动，14例出现融合迹象。
结论：采用经皮脊柱内镜辅助下腰椎椎体间融合术治疗腰椎退变性疾病具有微创、安全、有效的优势，临床效果显著，但其远期结果仍需多中心大样本的随访研究证实。 |
| 【关键词】腰椎 椎间盘移位 脊椎滑脱 脊柱融合术 手术后并发症 |
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| Clinical application of percutaneous transforaminal endoscope-assisted lumbar interbody fusion |
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ABSTRACT
Objective: To conclude of the technical notes of percutaneous transforaminal endoscope-assisted lumbar interbody fusion (PT-Endo-LIF),and to investigate its safety and efficacy for treatment of degenerative lumbar disease.
Methods: Twenty-four patients were treated by PT-Endo-LIF combined with posterior percutaneous pedicle screws fixation from October 2017 to April 2018. There were 16 males and 8 females,ranging in age from 39 to 72 years old,with a mean of (59.6±9.5) years old. There were 15 cases diagnosed with lumbar intervertebral disc herniation combined with degenerative disc,the other 9 cases were diagnosed as low level lumbar spondylolistheses w/o segmental instability. Single segmental fusion was performed for 22 cases(one for L2,3,3 for L3,4 and 18 for L4,5) and 2 segmental fusion was performed for the other 2 cases (both for L3,4 and L4,5). PT-Endo-LIF was performed under local anesthesia with conscious sedation,followed by decompression through endoscopic technics. After that,end-plate preparation and autogenous bone and expandable cage implantation were performed. Finally,percutaneous screws and rod instrumentation were used. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. The operation time,intraoperative bleeding volume,intraoperative and postoperative complications were recorded. All patients underwent X-ray,CT plain scan,three-dimensional reconstruction and MRI examination to evaluate the stability of the implants and fusion rate before 3 days and 1,3,6,12 and 18 months after operation.
Results: All patients were followed up,and the duration ranged from 12 to 18 months. The operation time of single-segment fusion was (192.3±22.7) min,and that of double-segment fusion was (272.5±24.7) min. The estimated intraoperative bleeding volume was less than 50 ml per segment,and no blood transfusion was performed in all patients. The VAS improved from preoperative 7.4±1.1 to postoperative 2.3±0.8 (t=-19.65,P<0.000 5). The ODI improved from preoperative (41.2±3.3)% to the final follow-up (12.3±2.5)%(t=-35.76,P<0.000 5). Postoperative complications occurred in 4 cases,and contralateral radicular symptoms occurred in 2 cases. After contralateral foraminoscopic decompression,the symptoms were completely alleviated. One case had neurological symptoms related to percutaneous screw placement,and the symptoms were alleviated after removal of the lateral screw rod internal fixation. The other cases had surgical incision infection and improved after debridement and suture. At the latest follow-up,no displacement or loosening of the fusion cage and screw rod system occurred in all patients,and 14 cases showed signs of fusion.
Conclusion: PT-Endo-LIF is a minimal invasive,safe and efficient surgical procedure for treatment of degenerative lumbar disease. Nevertheless,the long-term results still need to be confirmed by a multi-center and lagre sample follow-up study. |
| KEY WORDS Lumbar vertebrae Intervertebral disc displacement Spondylolysis Spinal fusion Postoperative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张骏,金梦然,赵廷潇,邵海宇,刘建文,陈锦平,陈炘佶,黄亚增.经皮脊柱内镜辅助下腰椎椎体间融合术及其临床应用[J].中国骨伤,2019,32(12):1138~1143 |
| 英文格式: | ZHANG Jun,JIN Meng-ran,ZHAO Ting-xiao,SHAO Hai-yu,LIU Jian-wen,CHEN Jin-ping,CHEN Xin-ji,HUANG Ya-zeng.Clinical application of percutaneous transforaminal endoscope-assisted lumbar interbody fusion[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(12):1138~1143 |
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