摘要
目的探讨微创经椎间孔腰椎椎间融合术(MIS-TLIF)治疗腰椎间盘突出肥胖患者围手术期临床疗效。方法回顾性分析2013年1月至2014年6月腰椎间盘突出肥胖患者56例,体重指数(BMI)均>30 kg/m2,分别行MIS-TLIF与开放性经椎间孔腰椎椎间融合术(Open-TLIF),其中MIS-TLIF组32例,Open-TLIF组24例。比较两组平均手术时间、术中出血量、切口长度、下地活动时间和平均住院时间、血液指标、并发症发生率等,并采用日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)进行术后临床疗效评估。结果Open-TLIF组手术时间为(200.00±43.05)min,术中出血量为(420.56±86.42)mL,切口长度为(8.00±4.01)cm,术后下床时间为(100.80±53.04)h,平均住院时间为(9.30±3.40)d,并发症发生率为8.33%,MIS-TLIF组手术时间为(120.00±28.26)min,术中出血量为(110.83±50.51)mL,平均住院时间为(5.00±2.52)d,术后下床时间为(24.37±8.50)h,切口长度为(2.50±0.18)cm,术后并发症发生率为6.25%,两组差异均有统计学意义(P<0.05)。术后1 d,MIS-TLIF组C反应蛋白(CRP)明显低于Open-TLIF组(P<0.05),两组白细胞计数(WBC)、红细胞沉降率(ESR)无统计学差异(P>0.05);术后3、5 d,MIS-TLIF组WBC、ESR、CRP均明显低于Open-TLIF组(P<0.05)。术后5 d,MIS-TLIF组JOA、VAS和ODI评分较Open-TLIF组显著改善(P<0.05);MIS-TLIF组术后并发症发生率明显少于Open-TLIF组(P<0.05)。结论对于腰椎间盘突出肥胖患者,MIS-TLIF具有失血量少、并发症少、平均住院时间短和术后恢复快等优点,是腰椎间盘突出肥胖患者未来治疗的趋势。
Objective To explore clinical effects of minimally invasive transforaminal lumbar interbody fusion （MIS‐TLIF） for the obese patients with lumbar disc herniation in peri operation period .Methods The retrospective analysis of 56 obese patients with lumbar disc herniation from January 2013 to June 2014 ,body mass index （BMI） of all patients was higher than 30 kg/m2 .There were 32 cases in MIS‐TLIF group and 24 cases in open transforaminal lumbar interbody fusion （Open‐TLIF） group . The average operation time ,intraoperative blood loss ,length of incision ,ambulation time ,hospitalization time ,blood indexes ,complication rate were compared between two groups . Japanese Orthopedic Association （JOA） score ,visual analogue scale （VAS） ,and Oswestry Dability Index （ODI） were assessed .Results The average operation time ,intraoperative blood loss ,length of incision ,ambulation time , hospitalization time ,complication rate were 200 .00 ± 43 .05 min ,420 .56 ± 86 .42 mL ,8 .00 ± 4 .01 cm ,100 .80 ± 53 .04 h ,9 .30 ± 3 .40 d and 8 .33% in Open‐TLIF group ,respectively .They were 120 .00 ± 28 .26 min ,110 .83 ± 50 .51 mL ,5 .00 ± 2 .52 d ,24 .37 ± 8 .50 h ,2 .50 ± 0 .18 cm and 6 .25% in MIS‐TLIF group ,respectively .There were significant differences between two groups （P〈 0 .05） .C reactive protein （CRP） in MIS‐TLIF group was＆amp;nbsp;significantly lower than that in Open‐TLIF group （P〈0 .05） ,and no significant difference of white blood cell count （WBC） ,erythrocyte sedimentation rate （ESR） was between two groups at 1 day postoperatively （P〉 0 .05） .WBC , ESR and CRP in MIS‐TLIF group were significantly lower than those in Open‐TLIF group at 3 , 5 days postoperatively （P〈0 .05） .JOA scores ,VAS scores and ODI in MIS‐TLIF group were better than those in Open‐TLIF group at 5 days postoperatively （P〈0 .05） .The complication rate in MIS‐TLIF group was significantly lower than that in Open‐TLIF group （P〈0 .05） .Conclusion MIS‐TLIF for the obese patients with lumbar disc herniation could have the advantages of less bleeding ,fewer complication rate ,shorter hospitalization time and quick recovery . It is the future trend of treatment for the obese patients with lumbar disc herniation .
出处
《国际骨科学杂志》
2015年第3期235-239,共5页
International Journal of Orthopaedics
基金
国家自然科学基金(51372276)
关键词
微创
开放
经椎间孔腰椎椎间融合
肥胖
腰椎间盘突出
Minimally invasive
Open
Transforaminal lumbar interbody fusion
Obesity
Lumbar disc herniation
作者简介
通信作者：毛克亚E-mail：maokeya@sina．com
