微创与开放经椎间孔腰椎椎间融合术组织创伤相关血清指标的比较研究_《中国修复重建外科杂志》

作者：

邹澍 , 王建 , 潘文琦 , 郑勇 , 黄博

第三军医大学新桥医院骨科（重庆，400037）;

关键词：

组织创伤炎性反应经椎间孔腰椎椎间融合术微创手术开放手术腰椎退行性疾病

DOI：

10.7507/1002-1892.20130209

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的比较微创经椎间孔腰椎椎间融合术（transforaminal lumbar interbody fusion，TLIF）与开放TLIF治疗腰椎退行性疾病组织创伤相关血清指标差异，分析其意义。方法将2012年5月－11月符合选择标准的60例患者纳入研究，根据患者对手术方式认同度、经济条件等情况确定手术方式，行Quadrant可扩张工作通道下经椎间孔椎管减压、椎间植骨融合、Sextant椎弓根螺钉内固定手术（微创组）及传统开放TLIF手术（开放组）各30例。两组患者性别、年龄、病变类型、病变节段、病程等一般资料比较差异均无统计学意义（P gt; 0.05），具有可比性。分别记录患者手术时间、术中出血量、术后住院时间等；应用疼痛视觉模拟评分（VAS）评估患者术后切口疼痛程度。检测两组患者术前及术后24 h C反应蛋白（C-reactive protein，CRP）浓度及肌酸激酶（creatine kinase，CK）活性；以及术前和术后2、4、8、24 h患者血清中IL-6、IL-10及TNF-α的浓度。结果微创组手术时间、术中出血量、术后住院时间及术后1～3 d切口VAS评分均少于开放组，差异有统计学意义（P lt; 0.05）。两组术前血清CRP浓度、CK活性、IL-6、IL-10及TNF-α浓度比较，差异均无统计学意义（P gt; 0.05）；术后24 h，微创组CRP浓度、CK活性及术后各时间点IL-6、IL-10浓度均低于开放组，差异均有统计学意义（P lt; 0.05），两组TNF-α浓度差异无统计学意义（P gt; 0.05）。结论微创TLIF导致的组织创伤及系统炎性反应较开放TLIF轻，对患者造成的手术创伤较小。

引用本文： 邹澍,王建,潘文琦,郑勇,黄博. 微创与开放经椎间孔腰椎椎间融合术组织创伤相关血清指标的比较研究. 中国修复重建外科杂志, 2013, 27(8): 960-964. doi: 10.7507/1002-1892.20130209 复制

1.	Cutler AR, Siddiqui S, Mohan AL, et al. Comparison of polyetheretherketone cage with emoral cortical bone allograft as a single-piece interbody spacer in tranaforaminal lumbar interbody fusion. J Neurosurg Spine, 2007, 5(6): 534-539.
2.	Lowe TG, Tahernia AD, O’Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2 year results. J Spinal Disord Tech, 2002, 15(1): 31-38.
3.	李兵, 胡朝晖, 卓祥龙. 经椎间孔椎体间融合治疗退行性腰椎间盘病. 中国修复重建外科杂志, 2008, 22(8): 914-917.
4.	Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
5.	Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive trmasforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1: S1-6.
6.	Seheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 Suppl 2): 203-213.
7.	Thelander U, Larsson S. Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery. Spine (Phila Pa 1976), 1997, 17(4): 400-404.
8.	Takahashi J, Ebara S, Kamimura M, et al. Early-phase enhanced inflammatory reaction after spinal in-strumentation surgery. Spine (Phila Pa 1976), 2001, 26(15): 1698-1704.
9.	Kawaguchi Y, Matsui H, Tsuji H, et al. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
10.	Kawaguchi Y, Yabuki S, Styf J, et al. Back muscle injury after posterior lumbar spine surgery. Topographic evlanation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine (Phila Pa 1976), 1996, 21(22): 2683-2688.
11.	王建, 张正丰, 李长青, 等. 微创经椎间孔腰椎椎间融合术翻修治疗腰椎退变性疾病. 脊柱外科杂志, 2012, 10(1): 13-16.
12.	Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TILF). Eur Spine J, 2005, 14(9): 887-894.
13.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
14.	Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10): 1780-1784.
15.	梁博伟, 殷国前, 赵劲民, 等. 微创经椎间孔椎间融合术治疗退变性腰椎失稳. 中国修复重建外科杂志, 2011, 25(12): 1449-1454.
16.	Huang TJ, Hsu RW, Li YY, et al. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res, 2005, 23(2): 406-411.
17.	Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976), 1997, 22(9): 1018-1023.
18.	张超, 周跃, 初同伟, 等. 椎间盘镜下与开放手术治疗腰椎间盘突出症对椎旁肌损伤程度的比较研究. 中国骨与关节损伤杂志, 2006, 21(4): 287-289.
19.	Kim YI, Song KE, Ryeon HK, et al. Enhanced inflammatory cytokine Production at ischemia/reperfusion in human liver resection. Hepatogastroenterology, 2002, 49(46): 1077-1082.
20.	Gogos CA, Drosou E, Bassaris HP, et al. Pro- versus anti-inflammatory cytokine profile in patients with severe sepsis: a marker for prognosis and future therapeutic options. J Infect Dis, 2000, 181(1): 176-180.

1. Cutler AR, Siddiqui S, Mohan AL, et al. Comparison of polyetheretherketone cage with emoral cortical bone allograft as a single-piece interbody spacer in tranaforaminal lumbar interbody fusion. J Neurosurg Spine, 2007, 5(6): 534-539.
2. Lowe TG, Tahernia AD, O’Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2 year results. J Spinal Disord Tech, 2002, 15(1): 31-38.
3. 李兵, 胡朝晖, 卓祥龙. 经椎间孔椎体间融合治疗退行性腰椎间盘病. 中国修复重建外科杂志, 2008, 22(8): 914-917.
4. Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
5. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive trmasforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1: S1-6.
6. Seheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 Suppl 2): 203-213.
7. Thelander U, Larsson S. Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery. Spine (Phila Pa 1976), 1997, 17(4): 400-404.
8. Takahashi J, Ebara S, Kamimura M, et al. Early-phase enhanced inflammatory reaction after spinal in-strumentation surgery. Spine (Phila Pa 1976), 2001, 26(15): 1698-1704.
9. Kawaguchi Y, Matsui H, Tsuji H, et al. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
10. Kawaguchi Y, Yabuki S, Styf J, et al. Back muscle injury after posterior lumbar spine surgery. Topographic evlanation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine (Phila Pa 1976), 1996, 21(22): 2683-2688.
11. 王建, 张正丰, 李长青, 等. 微创经椎间孔腰椎椎间融合术翻修治疗腰椎退变性疾病. 脊柱外科杂志, 2012, 10(1): 13-16.
12. Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TILF). Eur Spine J, 2005, 14(9): 887-894.
13. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
14. Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10): 1780-1784.
15. 梁博伟, 殷国前, 赵劲民, 等. 微创经椎间孔椎间融合术治疗退变性腰椎失稳. 中国修复重建外科杂志, 2011, 25(12): 1449-1454.
16. Huang TJ, Hsu RW, Li YY, et al. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res, 2005, 23(2): 406-411.
17. Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976), 1997, 22(9): 1018-1023.
18. 张超, 周跃, 初同伟, 等. 椎间盘镜下与开放手术治疗腰椎间盘突出症对椎旁肌损伤程度的比较研究. 中国骨与关节损伤杂志, 2006, 21(4): 287-289.
19. Kim YI, Song KE, Ryeon HK, et al. Enhanced inflammatory cytokine Production at ischemia/reperfusion in human liver resection. Hepatogastroenterology, 2002, 49(46): 1077-1082.
20. Gogos CA, Drosou E, Bassaris HP, et al. Pro- versus anti-inflammatory cytokine profile in patients with severe sepsis: a marker for prognosis and future therapeutic options. J Infect Dis, 2000, 181(1): 176-180.

《中国修复重建外科杂志》

微创与开放经椎间孔腰椎椎间融合术组织创伤相关血清指标的比较研究

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国修复重建外科杂志》

微创与开放经椎间孔腰椎椎间融合术组织创伤相关血清指标的比较研究

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料