Zhang Lei, Fang Xiangqian, Zhao Xing, Xu Wenbin, Liu Gang
Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou Zhejiang, 310036, P.R.China.
Department of Orthopaedics, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou Zhejiang, 310036,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 May 15;31(5):519-526. doi: 10.7507/1002-1892.201612131.
To assess the clinical application value of tranforaminal unilateral approach for bilateral decompression by comparing the short-term effectiveness of bilateral decompression via unilateral approach of intervertebral foramen with via small surgical incision of bilateral spinous process in lumbar interbody fusion for the treatment of lumbar spinal stenosis.
Between July 2014 and June 2015, 48 patients with lumbar spinal stenosis underwent decompression and internal fixation by unilateral approach in 24 cases (trial group) and by bilateral small incision approach in 24 cases (control group). There was no significant difference in gender, age, disease duration, disease type, involved segment, combined medical diseases, preoperative level of creatine phosphokinase (CPK), the visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups ( >0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, and the incidence of complications were recorded. The CPK levels were evaluated at 1, 3, and 7 days after operation. VAS score and ODI were used to evaluate the effectiveness, and lumbar X-ray film or CT scanning to determine the intervertebral bony fusion.
There was no significant difference in operation time, intraoperative blood loss, and hospitalization time between 2 groups ( >0.05), but significant difference was found in postoperative drainage ( =5.547, =0.000). At 1 day after operation, the level of CPK in the trial group was significantly lower than that in the control group ( =3.129, =0.005), but there was no significant difference at 3 and 7 days after operation between 2 groups ( >0.05). The patients were followed up 12-24 months (mean, 17 months). All the wounds healed primarily. Heart failure occurred in 1 case of the trial group, and cerebrospinal fluid leakage and pulmonary infection, and nerve root injury occurred in 1 case of the control group respectively. There was no significant difference in the incidence of complications between 2 groups ( =0.273, =0.602). The interbody fusion rate was 95.8% (23/24) in the trial group and was 91.7% (22/24) in the control group, showing no significant difference ( =0.356, =0.551). No cage sink, dislocation or plate and screw loosening and breakage was found in 2 groups. No adjacent segment degeneration occurred during the follow-up, and there was no change of scoliosis and lumbar sagittal curvature. At 3, 6, and 12 months after operation, the VAS score and ODI were significantly improved when compared with the preoperative scores in 2 groups ( <0.05), and the VAS score and ODI of the trial group were significantly better than those of control group ( <0.05).
The bilateral decompression via unilateral approach of intervertebral foramen and small surgical incision of bilateral spinous process in lumbar interbody fusion have satisfactory efficacy for the treatment of lumbar spinal stenosis, but the tranforaminal unilateral approach has the advantages of less trauma, avoidance of bilateral muscle stripping and soft paraspinal muscle injury, retention of posterior spinal structure, faster postoperative recovery, shorter hospital stay and good short-term effectiveness.
通过比较腰椎椎间融合术中经椎间孔单侧入路双侧减压与双侧棘突小切口双侧减压的短期疗效，评估经椎间孔单侧入路双侧减压的临床应用价值。
2014年7月至2015年6月，48例腰椎管狭窄症患者，24例行单侧入路减压内固定术（试验组），24例行双侧小切口减压内固定术（对照组）。两组患者在性别、年龄、病程、疾病类型、受累节段、合并内科疾病、术前肌酸磷酸激酶（CPK）水平、视觉模拟评分法（VAS）及Oswestry功能障碍指数（ODI）等方面比较，差异均无统计学意义（P>0.05）。记录手术时间、术中出血量、术后引流量、住院时间及并发症发生率。术后1、3、7天评估CPK水平。采用VAS评分和ODI评估疗效，腰椎X线片或CT扫描确定椎间骨性融合情况。
两组手术时间、术中出血量及住院时间比较，差异无统计学意义（P>0.05），但术后引流量差异有统计学意义（t=5.547，P=0.000）。术后1天，试验组CPK水平显著低于对照组（t=3.129，P=0.005），术后3、7天两组比较差异无统计学意义（P>0.05）。患者随访12～24个月（平均17个月）。所有伤口均一期愈合。试验组1例发生心力衰竭，对照组分别有1例发生脑脊液漏、肺部感染及神经根损伤。两组并发症发生率比较，差异无统计学意义（χ²=0.273，P=0.602）。试验组椎间融合率为95.8%（23/24），对照组为91.7%（22/24），差异无统计学意义（χ²=0.356，P=0.551）。两组均未发现椎间融合器下沉、移位或钢板螺钉松动、断裂。随访期间未发生相邻节段退变，脊柱侧弯及腰椎矢状位曲度无变化。术后3、6、12个月，两组VAS评分和ODI均较术前显著改善（P<0.05），且试验组VAS评分和ODI均显著优于对照组（P<0.05）。
腰椎椎间融合术中经椎间孔单侧入路双侧减压与双侧棘突小切口双侧减压治疗腰椎管狭窄症疗效均满意，但经椎间孔单侧入路具有创伤小、避免双侧肌肉剥离及椎旁软组织损伤、保留脊柱后结构、术后恢复快、住院时间短及短期疗效好等优点。
