切除部分上关节突经椎间孔入路椎间融合内固定在高位腰椎间盘突出症治疗中的应用

doi:10.3760/cma.j.cn 101202-20230723-00018

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摘要目的探讨切除部分上关节突后经椎间孔入路椎间融合内固定治疗高位腰椎间盘突出症的可行性及临床疗效。方法横断面研究。纳入2018年1月—2021年6月新疆医科大学第一临床医学院综合外科骨科组高位腰椎间盘突出症患者39例,其中男21例、女18例,年龄21~73（51.2±10.7）岁。39例中,L_1/2腰椎间盘突出4例、L_2/3腰椎间盘突出22例、L_3/4腰椎间盘突出13例,均采用切除部分上关节突经椎间孔入路椎间融合内固定术治疗。观察项目：（1）观察患者手术情况及并发症发生情况;（2）分别于术前及术后2周使用疼痛视觉模拟评分法（VSA）评分评估患者手术前后疼痛程度;（3）分别于术前、术后6个月采用Oswestry功能障碍指数（ODI）评估患者的症状及功能;（4）测量并比较手术前后责任椎间隙相对高度;（5）分别于术前及末次随访根据肌力评估量表（MMT）评估患者肌力变化情况;（6）综合评估患者椎间融合时间。结果 39例患者手术均顺利且获得随访,随访时间9~16（11.6±2.0）个月。手术时间90~155（115.9±17.7） min,术中出血量50~150（98.7±27.8） mL,术中无硬脊膜、神经、大血管损伤。术后患者VAS评分和ODI分别为（1.71±0.45）分和20.13%±3.34%,较术前的（8.13±0.65）分和52.41%±6.86%有明显降低,差异均有统计学意义（t=53.30,24.38, P值均<0.001）。术后责任椎间隙相对高度为（0.33±0.03） mm,较术前的（0.20±0.03） mm增加,差异有统计学意义（t=-18.51,P<0.001）。术前患者肌力均有降低,其中C级6例、D级14例、E级19例,末次随访时2例术前肌力C级患者肌力无明显改善,其余患者神经功能获得不同程度改善,其中C级2例、D级2例、E级35例。39例患者中,30例为椎间融合器融合,9例为混合椎间植骨融合,其中1例采用椎间融合器融合患者在随访16个月时仍未融合,其余患者椎间融合时间为6~14（9.6±1.6）个月。结论切除部分上关节突经椎间孔入路椎间融合内固定治疗高位腰椎间盘突出症,安全性高、不干扰神经功能、并发症少,可作为高位腰椎间盘突出症手术治疗的选择方法。

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	李忠伟
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关键词 ：椎间盘移位, 脊柱融合术, 高位腰椎间盘突出症, 椎间孔入路, 椎间盘切除术

Key words： Intervertebral disc displacement Spinal fusion High lumbar disc herniation Foraminal approach Diskectomy.

收稿日期: 2023-07-23

通讯作者: 李忠伟, Email:3146387571@qq.com

引用本文:

李忠伟, 张树文, 杨新明, 银乐乐, 崔泳. 切除部分上关节突经椎间孔入路椎间融合内固定在高位腰椎间盘突出症治疗中的应用[J]. 中华解剖与临床杂志, 2024, 29(2): 116-119.
Li Zhongwei, Zhang Shuwen, Yang Xinming, Yin Lele, Cui Yong. Clinical study on the treatment of upper lumbar disc herniation by interbody fusion and internal fixation through the transforaminal approach. Chinese Journal of Anatomy and Clinics, 2024, 29(2): 116-119.

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[1]	Jing Z, Li L, Song J.Percutaneous transforaminal endoscopic discectomy versus microendoscopic discectomy for upper lumbar disc herniation: a retrospective comparative study[J]. Am J Transl Res, 2021,13(4):3111-3119.
[2]	李玉伟,王海蛟,王义生,等.PTED 与 TLIF治疗高位腰椎间盘突出症的效果比较[J].中华医学杂志,2018,98(2):113-116.DOI:10.3760/cma.j.issn.0376-2491.2018.02.008.Li YW, Wang HJ, Wang YS,et al.Comparison of percutaneous endoscopic lumbar discectomy versus transforaminal lumbar interbody fusion in treating upper lumbar disc herniation[J]. Natl Med J China,2018,98(2):113-116.DOI:10.3760/cma.j.issn.0376-2491.2018.02.008.
[3]	Li ZZ, Hou SX, Shang WL, et al.Modified percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar discectomy: instrument design, technique notes, and 5 years follow-up[J]. Pain Physician, 2017,20(1):E85-E98.
[4]	胡慧敏,王哲,罗卓荆,等. 椎板减压经椎间孔椎间盘切除椎间融合内固定治疗高位椎间盘突出症[J].中国脊柱脊髓杂志, 2010,20(7):537-540. DOI:10.3969/j.issn.1004-406X.2010.07.03.Hu HM, Wang Z, Luo ZJ, et al.Laminectomy with transforaminal discectomy and lumbar interbody fusion for upper lumbar disc herniation[J]. Chinese Journal of Spine and Spinal Cord, 2010,20(7):537-540. DOI:10.3969/j.issn.1004-406X.2010.07.03.
[5]	Heo DH,Lee DK,Lee DC,et al.Fully endoscopic transforaminal lumbar discectomy for upward migration of upper lumbar disc herniation: clinical and radiological outcomes and technical considerations[J].Brain Sci, 2020,10(6): 363. DOI: 10.3390/brainsci10060363.
[6]	杨小彬,郝定均,贺宝荣,等.不同融合术式治疗腰椎间盘突出并腰椎失稳的远期疗效[J].实用骨科杂志,2020,26(1):56-59. DOI:10.13795/j.cnki.sgkz.2020.01.014.Yang XB, Hao DJ, He BR, et al.Long-term efficacy of different fusion methods in the treatment of lumbar disc herniation and lumbar instability[J]. Journal of Practical Orthopaedics, 2020, 26(1):56-59. DOI:10.13795/j.cnki.sgkz.2020.01.014.
[7]	Shin MH, Bae JS, Cho HL, et al.Extradiscal epiduroscopic percutaneous endoscopic discectomy for upper lumbar disc herniation a technical note[J]. Clin Spine Surg, 2019,32(3):98-103. DOI: 10.1097/BSD.0000000000000755.
[8]	林宏衡,张文财,原超,等. 高位腰椎间盘突出症的手术治疗方法选择[J]. 中国骨与关节损伤杂志,2018, 33(5):478-480. DOI:10.7531/j.issn.1672-9935.2018.05.008.Lin HH, Zhang WC, Yuan C, et al.Selection of surgical treatment for upper lumbar herniation[J]. Chin J Bone Joint Injury, 2018, 33(5):478-480. DOI:10.7531/j.issn.1672-9935.2018.05.008.
[9]	Shin MH, Bae JS, Cho HL, et al.Extradiscal epiduroscopic percutaneous endoscopic discectomy for upper lumbar disc herniation a technical note[J]. Clin Spine Surg, 2019,32(3):98-103. DOI: 10.1097/BSD.0000000000000755.
[10]	Stamatiou D, Skandalakis JE, Skandalakis LJ, et al.Lumbar hernia: surgical anatomy, embryology, and technique of repair[J]. Am Surg, 2009,75(3):202-207.
[11]	Li Z, Zhang C, Chen W, et al.Percutaneous endoscopic transforaminal discectomy versus conventional open lumbar discectomy for upper lumbar disc herniation: a comparative cohort study[J]. Biomed Res Int, 2020,2020:1852070. DOI: 10.1155/2020/1852070.
[12]	Fei H, Li WS, Sun ZR, et al.Analysis of spino-pelvic sagittal alignment in young Chinese patients with lumbar disc herniation[J]. Orthop Surg, 2017,9(3):271-276. DOI: 10.1111/os.12340.
[13]	李利军,孙久强,宋洁富.1切2中垂直内移测量法在高位腰椎间盘突出症经皮椎间孔镜侧路手术治疗中的应用[J].中华解剖与临床杂志,2020,25(1):43-48. DOI:10.3760/cma.j.issn.2095-7041.2020.01.008.Li LJ, Sun JQ, Song JF.The application of 1 tangent line 2 midpoint vertical shift measurement method in the treatment of upper lumbar intervertebral disc herniation by percutaneous transforminal endoscopic discectomy[J]. Chin J Anat Clin,2020,25(1):43-48. DOI:10.3760/cma.j.issn.2095-7041.2020.01.008.
[14]	郭晓辉,刘兰泽,栾媛媛,等.改良TLIF 技术在高位腰椎间盘突出症治疗中的应用[J].实用骨科杂志, 2015,21(5):394-396. DOI: 10.13795/j.cnki.sgkz.2015.05.006.Guo XH, Liu LZ, Luan YY, et al.Application of modified TLIF technique in the treatment of high lumbar disc herniation[J]. Journal of Practical Orthopaedics, 2015, 21(5) : 394-396. DOI:10.13795/j.cnki.sgkz.2015.05.006.
[15]	Stark JR, Hsieh J, Waller D.Bone graft substitutes in single- or double-level anterior cervical discectomy and fusion: a systematic review[J]. Spine (Phila Pa 1976), 2019,44(10):E618-E628. DOI: 10.1097/BRS.0000000000002925.
[16]	Suchomel P, Barsa P, Buchvald P, et al.Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern[J]. Eur Spine J, 2004,13(6):510-515. DOI: 10.1007/s00586-003-0667-z.