天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (7): 910-913.doi: 10.11958/20160212

• 新技术交流 • 上一篇    下一篇

可动式椎间盘镜下MED-TLIF的设计与临床应用

徐宝山1,马信龙2,杨强3,刘越1,姜洪丰1,许海委4,吉宁5   

  1. 天津医院微创脊柱外科
  • 收稿日期:2016-03-28 修回日期:2016-04-08 出版日期:2016-07-15 发布日期:2016-07-15
  • 作者简介:徐宝山（1971）， 男， 博士， 主任医师， 教授， 博士生导师， 主要从事微创脊柱外科及椎间盘组织工程相关研究
  • 基金资助:
    国家自然科学基金资助项目（81272046）， 天津市自然科学基金资助项目（15JCYBJC25300）， 天津市卫生局攻关课题（14KG121）

The design and clinical application of MED-TLIF with mobile microendoscopic discectomy technique.

XU Baoshan, MA Xinlong, YANG Qiang, LIU Yue, JIANG Hongfeng, XU Haiwei, JI Ning   

  1. Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin 300211, China
  • Received:2016-03-28 Revised:2016-04-08 Published:2016-07-15 Online:2016-07-15

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摘要： 目的 探讨可动式椎间盘镜（mobile MED, MMED）下经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion, TLIF）的方法与临床应用价值。 方法 MMED由外套管和内套管构成，根据镜下TLIF操作需要，研制可通过12、14mm高度融合器的大号外套管和镜下骨凿。设计手术方法：在症状严重侧的椎弓根入钉点之间行纵行切口，经肌间隙安置外套管，显露关节突关节，MMED下经椎间孔入路神经减压，刮除椎间盘和终板软骨，退出内套管，椎间隙内植骨并安置融合器，透视下置入经皮椎弓根螺钉，进一步复位固定。临床应用MMED行MED-TLIF手术治疗腰椎退变性疾病56例，包括椎管狭窄伴失稳32例，1度滑脱15例，2度滑脱9例，节段包括L45 31例、L5S1 23例、L4-S1 2例。结果 所有患者均顺利完成手术，无中转开放手术者，未发生神经损伤。手术时间90-180min，平均120min，术中出血50-250ml，平均150ml。术后X线和CT示内固定位置良好，滑脱复位率平均72%。术后随访6-36个月，术前ODI平均50.1±11.2，末次随访5.8±5.6，腰痛VAS评分术前7.1±4.2，末次随访1.1±1.1，腿痛VAS评分术前4.1±2.5，术后0.9±0.9。根据MacNab标准优36例，良20例。结论：MMED下MED-TLIF操作方便，可在兼顾减压的基础上达到满意的复位和融合固定，同时减少手术创伤和稳定结构破坏。

关键词: 椎间盘移位, 外科手术, 微创性, 椎管狭窄, 内固定器, 椎间盘镜, 经椎间孔腰椎椎体间融合术, 经皮固 定, 腰椎管狭窄

Abstract: Objective: To evaluate the feasibility and clinical efficacy of microendoscopic discectomy-transforaminal lumbar interbody fusion (MED-TLIF) with mobile microendoscopic discectomy (MMED) technique. Methods: The MMED include outer working canal and inner operating canal, and large working canals and endoscopic chisel were fabricated for this operation. Operation was designed as follow: the pedicles and index level were located with fluoroscopy, and a 2.5cm incision was made between pedicle punctures sites on the side with prominent symptom. Working canal was inserted and the facet was exposed, the inferior articular process and medial part of superior articular process were resected. The disc and cartilage endplates were curettage, and the intervertebral space was released and tested. The inner operating canal was removed and the interbody space was grafted and supported with suitable cage. Percutaneous pedicles screws were inserted and the residual displacement was evaluated under fluoroscopy, followed by the install of connecting rods, reduction and fivation. Fifty-six patients of lumbar stenosis with instability (32 cases) and spondylolisthesis (1 degree in 15 cases and 2 degree in 9 cases) were treated by this technique, and the index levels included L4/5 in 32 and L5S1 in 24 patients. The operation data and follow-up results were recorded and evaluated. Results: Surgery was successful in all patients, with no nerve injury or conversion to open surgery. The mean operative time was 120 min (range, 90–180 min), with a mean blood loss of 150 ml (range, 50–250 ml). The post-op X-ray and CT scans showed improvement of spinal alignment with mean reduction ratio of 72%. Patients were followed up for 12 to 36 months, the ODI score decreased from 50.1±11.2 pre-op to 5.8±5.6, VAS of lumbar decreased from 7.1±4.2 to 1.1±1.1 and VAS of leg decreased from 4.1±2.5 to 0.9±0.9 at final follow-up. The clinical results were excellent in 36 cases, good in 20 according to the MacNab scale. Conclusion: MED-TLIF can easily performed with MMED technique, with sufficient decompression and reduction, providing satisfactory results with less invasive procedure.

Key words: Microendoscopic discectomy, transforaminal lumbar interbody fusion, Percutanous fixation, Lumbar spine stenosis