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JSDT：肥胖患者微创椎间孔腰椎间融合术安全可靠

2014-07-09 lining117826 丁香园

椎间孔融合术椎管狭窄椎板切除ODI
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肥胖被认为是腰痛的独立危险因素。美国国立卫生研究院对肥胖的分级如下规定：BMI在25-30间为超重，30-40则为肥胖。外科医生认为，肥胖患者手术暴露困难，手术时间较非肥胖患者延长。并且，有研究认为，超重或肥胖患者行选择性脊柱融合的围手术期并发症发生率为36.9%。 目前，肥胖和非肥胖患者行微创或开放脊柱手术的研究有大量报道，然而，没有研究比较超重或肥胖患者行微创或开放椎间孔腰椎融合术的疗效

肥胖被认为是腰痛的独立危险因素。美国国立卫生研究院对肥胖的分级如下规定：BMI在25-30间为超重，30-40则为肥胖。外科医生认为，肥胖患者手术暴露困难，手术时间较非肥胖患者延长。并且，有研究认为，超重或肥胖患者行选择性脊柱融合的围手术期并发症发生率为36.9%。

目前，肥胖和非肥胖患者行微创或开放脊柱手术的研究有大量报道，然而，没有研究比较超重或肥胖患者行微创或开放椎间孔腰椎融合术的疗效差异。为了评价超重或肥胖患者行微创或开放椎间孔腰椎融合术的临床结果及安全性，来自中国三军大的学者Wang Jian等进行了一项前瞻性对比研究，该研究结果已在近期的Journal of Spinal Disorders & Techniques杂志上发表。

在该研究中，81例患者（25男，56女，平均年龄55.3岁）获得了随访，其中椎管狭窄患者43名，腰椎滑脱患者29名，椎板切除不稳定患者9名。患者平均随访时间为36.1月。其中，微创组42人，平均BMI为29.5，开放组39人，平均BMI为28.3（表1）

表1 纳入患者的基本特征


该研究结果显示：微创组椎间孔镜手术患者手术时间短、术中及术中失血量少和术后疼痛轻。在ODI指数、融合率方面，微创组和开放组椎间孔镜手术疗效显著改善，但无明显统计学差异。而在并发症发生率方面，微创组和开放组分别为9.5%和17.9%（p<0.05）(表2)，这可能是因为开放椎间孔镜手术切口大、软组织创伤大、失血量多造成的。
表2 临床结果的比较


本研究的不足为：1.该研究为非随机对照研究，为了获得更可信的结论，随机对照研究仍是需要的；2.该研究样本相对较小。

该研究表明，微创椎间孔腰椎间融合术治疗超重或肥胖患者，其疗效安全可靠。

原始出处：

Wang J1, Zhou Y, Feng Zhang Z, Qing Li C, Jie Zheng W, Liu J.Comparison of the clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion.J Spinal Disord Tech. 2014 Jun;27(4):202-6. doi: 10.1097/BSD.0b013e31825d68ac.


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    2015-01-27 liuquan

    #肥胖患者#

    0

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    2014-11-24 ms622625817193301

    #椎间孔#

    0

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    2014-11-01 redcrab

    #椎间融合术#

    0

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    2014-07-11 anminleiryan

    #腰椎#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1950944, encodeId=f3f61950944df, content=<a href='/topic/show?id=72078190803' target=_blank style='color:#2F92EE;'>#肥胖患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81908, encryptionId=72078190803, topicName=肥胖患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Jan 27 22:22:00 CST 2015, time=2015-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1736633, encodeId=1c731e366331c, content=<a href='/topic/show?id=0192628906a' target=_blank style='color:#2F92EE;'>#椎间孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62890, encryptionId=0192628906a, topicName=椎间孔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=273734174228, createdName=ms622625817193301, createdTime=Mon Nov 24 17:22:00 CST 2014, time=2014-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1998684, encodeId=8472199868400, content=<a href='/topic/show?id=784a62906d9' target=_blank style='color:#2F92EE;'>#椎间融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62906, encryptionId=784a62906d9, topicName=椎间融合术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85aa264, createdName=redcrab, createdTime=Sat Nov 01 04:22:00 CST 2014, time=2014-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272022, encodeId=c7b812e202261, content=<a href='/topic/show?id=cd1a854340b' target=_blank style='color:#2F92EE;'>#腰椎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85434, encryptionId=cd1a854340b, topicName=腰椎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316947, encodeId=b592131694e42, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525394, encodeId=0bd81525394e1, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546179, encodeId=bdd615461e92f, content=<a href='/topic/show?id=807a8886416' target=_blank style='color:#2F92EE;'>#融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88864, encryptionId=807a8886416, topicName=融合术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e99213890117, createdName=12498cb5m17暂无昵称, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=)]
    2014-07-11 vera_1203

    #微创#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1950944, encodeId=f3f61950944df, content=<a href='/topic/show?id=72078190803' target=_blank style='color:#2F92EE;'>#肥胖患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81908, encryptionId=72078190803, topicName=肥胖患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Jan 27 22:22:00 CST 2015, time=2015-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1736633, encodeId=1c731e366331c, content=<a href='/topic/show?id=0192628906a' target=_blank style='color:#2F92EE;'>#椎间孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62890, encryptionId=0192628906a, topicName=椎间孔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=273734174228, createdName=ms622625817193301, createdTime=Mon Nov 24 17:22:00 CST 2014, time=2014-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1998684, encodeId=8472199868400, content=<a href='/topic/show?id=784a62906d9' target=_blank style='color:#2F92EE;'>#椎间融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62906, encryptionId=784a62906d9, topicName=椎间融合术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85aa264, createdName=redcrab, createdTime=Sat Nov 01 04:22:00 CST 2014, time=2014-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272022, encodeId=c7b812e202261, content=<a href='/topic/show?id=cd1a854340b' target=_blank style='color:#2F92EE;'>#腰椎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85434, encryptionId=cd1a854340b, topicName=腰椎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316947, encodeId=b592131694e42, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525394, encodeId=0bd81525394e1, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546179, encodeId=bdd615461e92f, content=<a href='/topic/show?id=807a8886416' target=_blank style='color:#2F92EE;'>#融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88864, encryptionId=807a8886416, topicName=融合术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e99213890117, createdName=12498cb5m17暂无昵称, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=)]
    2014-07-11 licz0427

    #融合#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1950944, encodeId=f3f61950944df, content=<a href='/topic/show?id=72078190803' target=_blank style='color:#2F92EE;'>#肥胖患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81908, encryptionId=72078190803, topicName=肥胖患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Jan 27 22:22:00 CST 2015, time=2015-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1736633, encodeId=1c731e366331c, content=<a href='/topic/show?id=0192628906a' target=_blank style='color:#2F92EE;'>#椎间孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62890, encryptionId=0192628906a, topicName=椎间孔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=273734174228, createdName=ms622625817193301, createdTime=Mon Nov 24 17:22:00 CST 2014, time=2014-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1998684, encodeId=8472199868400, content=<a href='/topic/show?id=784a62906d9' target=_blank style='color:#2F92EE;'>#椎间融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62906, encryptionId=784a62906d9, topicName=椎间融合术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85aa264, createdName=redcrab, createdTime=Sat Nov 01 04:22:00 CST 2014, time=2014-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272022, encodeId=c7b812e202261, content=<a href='/topic/show?id=cd1a854340b' target=_blank style='color:#2F92EE;'>#腰椎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85434, encryptionId=cd1a854340b, topicName=腰椎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316947, encodeId=b592131694e42, content=<a href='/topic/show?id=df8950505a2' target=_blank style='color:#2F92EE;'>#微创#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50505, encryptionId=df8950505a2, topicName=微创)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644e456, createdName=vera_1203, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525394, encodeId=0bd81525394e1, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546179, encodeId=bdd615461e92f, content=<a href='/topic/show?id=807a8886416' target=_blank style='color:#2F92EE;'>#融合术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88864, encryptionId=807a8886416, topicName=融合术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e99213890117, createdName=12498cb5m17暂无昵称, createdTime=Fri Jul 11 00:22:00 CST 2014, time=2014-07-11, status=1, ipAttribution=)]
    2014-07-11 12498cb5m17暂无昵称

    #融合术#

    0

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