经可扩张通道管手术系统微创治疗下腰椎疾患

目的探讨运用扩张通道管系统(X-Tube)微创行经椎间孔腰椎椎体间融合术(trans-foraminal lumbar interbody fusion,TLIF)治疗下腰椎疾患的临床疗效。方法 38例腰椎退变性疾病及椎间盘突出患者,经X-Tube微创行TLIF,均采用单侧神经孔入路行椎间盘摘除、椎间植骨融合。结果本组平均手术时间150(110~260)min,平均出血量120(80~320)ml,手术切口长度平均3(2.8~3.5)cm,术后平均住院时间12.4(5~20)d。38例均获随访,平均2.5年(3月~4.5年)。疗效按照Nakai分级标准,优25例(65.8%),良11例(28.9%),可2例(5.3%)。5例患者(13.2%)发生并发症:手术切口皮缘局限性坏死1例,经换药愈合;脑脊液漏2例,经保守治疗痊愈;术后再次出现术侧下肢放射痛2例,经再次手术探查治愈。结论经X-Tube微创TLIF治疗下腰椎疾患具有手术切口小、腰骶肌肉剥离轻、术中出血量少、创伤小、术后恢复快、短期疗效确切等优点。

Mini-invasive Transforaminal Lumbar Interbody Fusion Assisted by X-Tube System in the Treatment of Low Back Disorders

Objective To explore the clinical effect of mini-invasive transforaminal lumbar interbody fusion（TLIF） assisted by X-Tube system for the treatment of low back disorders.Method 38 patients suffered lumbar disc herniation combined with segmental instability and lumbar spondylolisthesis with part defect were performed mini-invasive TLIF assisted with X-Tube system.Results Of the 38 patients,the operation duration was 150～260 minutes with an average of 150 minutes,the blood loss was 80 to 320 m1 with an average of 120 ml,the incision length was 2.8 to 3.5 cm with an average of 3 cm,and the hospital stay was 5 to 20 days with an average of 12.4 days.All cases were followed up for 3 months to 4.5 years（averagely 2.5 years）.According to Nakai criteria,the outcomes revealed excellence in 25 cases（65.8%）,good in l1 cases（28.9%） and fair in 2 cases（5.3%）.Postoperative complications were found in 5 cases（13.2%）： Limited necrosis of incision margin in 1 case and cured by change dressings,leakage of cerebrospinal fluid in 2 cases and cured by expectant treatment,and radiating pain of operation side in 2 cases and cured by reoperation of exploration.Conclusion Mini-invasive TLIF assisted by X-Tube system has the advantages such as small incision,slight stripping of paraspinal muscle,less blood loss and tissue trauma,short operative duration,rapid recovery and definite short-term results.