李东风

【摘要】 目的：评估微创经椎间孔椎体间融合术（minimal invasive transforaminal lumbar interbody fusion，MIS-TLIF）用于早期治疗腰椎间盘突出症和退行性椎管狭窄症的效果。方法：选取笔者所在医院2017年6月-2018年6月收治的24例腰椎间盘突出症和退行性腰椎管狭窄症患者，患者均接受MIS-TLIF结合单侧方法进入行双侧减压，记录手术时间、术中出血量、术后住院时间、并发症等。观察手术前后影像学变化、疼痛VAS评分、JOA评分和ODI评分。在最后一次随访中使用MacNab标准评估临床疗效。结果：所有患者均手术成功，无硬脊膜撕裂、神经根损伤等并发症。手术时间为（127.5±20.5）min，术中出血量为（247.7±40.7）ml，术后住院时间为（10.8±4.5）d。术后3 d及末次随访时患者VAS评分、ODI评分均低于术前，JOA评分均高于术前，差异均有统计学意义（P<0.01）。末次随访时優18例，良5例，可1例，优良率为95.83%（23/24）。结论：微创经椎间孔椎体间融合术治疗腰椎间盘突出症和退行性椎管狭窄症是令人满意的。长期疗效需要进一步跟进。

【关键词】 微创经椎间孔椎体间融合术 退变性腰椎管狭窄 腰椎退变性疾病

doi：10.14033/j.cnki.cfmr.2019.29.009 文献标识码 B 文章编号 1674-6805（2019）29-00-03

[Abstract] Objective： To evaluate the early efficacy of minimal invasive transforaminal lumbar interbody fusion （MIS-TLIF） in the treatment of lumbar disc herniation and degenerative spinal stenosis. Method： From June 2017 to June 2018， 24 patients with lumbar disc herniation and degenerative lumbar spinal stenosis in our department were treated with MIS-TLIF combined with bilateraldecompression through unilateral approach. The operation time， intraoperative bleeding volume， hospital stay and complications were recorded. The imaging changes， pain VAS scores， JOA scores， and ODI scores before and after surgery were observed. The clinical efficacy was assessed using the MacNab standard in the last follow-up. Result： All patients successfully completed the operation without any complications such as dural tear and nerve root injury. The operation time was （127.5±20.5） minutes， the amount of bleeding during the operation was （247.7±40.7） ml， and the hospital stay was （10.8±4.5） days after the operation. The VAS score and ODI of lumbago and leg pain at 3 days after operation and at the last follow-up were significantly improved compared with those before operation， and the differences were statistically significant （P<0.05）. At the last follow-up， 18 cases were excellent， 5 cases were good and 1 case was fair. The excellent and good rate was 95.83% （23/24）. Conclusion： Minimally invasive transforaminal lumbar interbody fusion for lumbar disc herniation and degenerative spinal stenosis is satisfactory in the early stage， and the long-term effect needs further follow-up observation.

[Key words] Minimally invasive transforaminal lumbar interbody fusion Degenerative lumbar spinal stenosis Lumbar degenerative diseases

First-authors address： Xuzhou Mercy Hospital， Xuzhou 221000， China

腰椎间盘突出症和退行性椎管狭窄是导致腰痛的常见疾病。虽然经典的全椎板切除术具有足够的减压作用，但它对脊柱的后部结构有很大的损害。因此，在完全减压的同时保持脊柱的生物力学稳定性的微创减压手术越来越受到国内外脊柱外科医生的重视。Foley等提出了微创经椎间孔椎体间融合术（MIS-TLIF）的概念，逐渐被大家所接受[1]。近年来，MIS-TLIF技术已经被认为是腰椎退变性疾病治疗的有效方法，且获得了良好的临床结果，与传统的开放手术相比，MIS-TLIF具有损伤小，出血少，术后恢复快的优点[2]。因此本研究通过回顾性研究笔者所在科室2017年6月-2018年6月收治的24例手术患者，评价其临床疗效，具体如下。……