微创与开放经椎间孔椎间融合术治疗腰椎不稳的疗效比较

Effect comparison between open TLIF and Mis-TLIF in the treatment of degenerative lumbar instability

目的：评价Quadrant通道下经椎间孔椎间融合术（微创TLIF）与开放经椎间孔椎间融合术（开放TLIF）两种手术方式治疗退变性腰椎不稳的临床效果。方法将53例腰椎不稳症患者分别采用开放TLIF（34例）和微创TLIF（19例）治疗,比较两组的手术时间、术中失血量、术中透视时间、术后并发症以及ODI、VAS评分等指标。结果2例失访,51例获得随访,时间3-12个月。术中失血量、并发症发生率：微创TLIF组均少于开放TLIF组（P〈0．05）；手术时间与术中透视时间：微创TLIF组均长于开放TLIF组（P〈0．05）；腰背痛VAS评分：微创TLIF组术后2周、12个月时低于开放TLIF组（P〈0．05）,术后3个月时两组比较差异无统计学意义（P〉0．05）。 ODI评分：术后2周、3个月、12个月两组比较差异均无统计学意义（P〉0．05）。两组在术后12个月随访时均未发生植骨不融合。结论微创TLIF是治疗腰椎不稳症的有效方法。

Objective To evaluate the effects of Mis-TLIF and open TLIF in the treatment of lumbar spine instabili-ty. Methods Fifty-three patients suffered from lumbar spine instability were treated by two different methods：Mis-TLIF（19 cases） and open TLIF（34 cases）. And clinical effects of these two methods were compared through the a-nalysis of the following parameters： operation time, mean blood loss, X-ray radiation time, complication incidence rate and Oswestry disability index （ ODI） , visual analogue scale （ VAS） , etc. Results Fifty-one patients were fol-lowed up for 3-12 months and 2 cases were lost to follow-up. The Mis-TLIF patients had a significantly longer opera-tion time, less blood loss and lower complication incidence rate （P〈0. 05） and the Mis-TLIF group had more radia-tion than open TLIF group （P〈0. 05）. Mis-TLIF groups had better improvements in VAS at 2 weeks and 12 months （P〈0. 05）, and there was no difference between them at 3 months after surgery（P〉0. 05）. ODI scores showed no statistical difference in Mis-TLIF compared with open TLIF at 2 weeks, 3 months and 12 months （P〉0. 05）. And both groups showed great interbody fusion rate at 12 months. Conclusions Mis-TLIF is an effective method in the treatment of lumbar spine instability.