微创经后路腰椎椎间融合术治疗退行性腰椎滑脱症的临床疗效分析

Clinical analysis of minimally invasive posterior lumbar interbody fusion for degenerative spondylolisthesis

背景:腰椎滑脱症是常见的腰椎退行性疾病,手术治疗的创伤较大以及滑脱复位是难点,目前脊柱外科微创技术应用广泛,应用微创技术治疗腰椎滑脱症患者康复更快。目的:分析微创经后路腰椎椎间融合术(MIS-PLIF)治疗退行性腰椎滑脱症的临床疗效。方法:前瞻性选择2017年1月至2018年6月收治的退行性腰椎滑脱症患者40例,依据随机数字表法随机分为两组,每组各20例。分别采用MIS-PLIF(MIS-PLIF组)和传统PLIF(PLIF组)治疗。记录并比较两组患者术中出血量、手术时间、术后引流量、卧床时间、住院总时间,以及手术前后腰痛、腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。结果:与传统PLIF组患者比较,MIS-PLIF组患者术中出血量、术后引流量更少(P均<0.01),卧床时间、住院总时间更短(P均<0.01)。两组患者术后腰痛、腿痛VAS评分及ODI均较术前改善(P均<0.05)。术后3 d、1个月、3个月MIS-PLIF组患者腰痛VAS评分低于PLIF组患者(P<0.05),ODI均高于PLIF组患者(P均<0.05);两组患者术后6个月、12个月腰痛VAS评分、ODI差异均无统计学意义(P均>0.05);而两组患者术后腿痛VAS评分差异均无统计学意义(P均>0.05)。结论:MIS-PLIF治疗退行性腰椎滑脱症的临床疗效、手术安全性与传统PLIF相当,且术中出血量少、卧床时间短、术后引流量少、住院时间短,能减轻患者术后疼痛,提高患者生活质量及康复的信心。

Background:Lumbar spondylolisthesis is a common degenerative lumbar disease,the traditional surgical treatment of trauma and spondylolisthesis reduction is difficult,now minimally invasive spinal surgery technology is widely used,the application of minimally invasive technology in the treatment of lumbar spondylolisthesis can make patients recover faster.Objective:To investigate the clinical effects and operative essentials of minimally invasive surgery-posterior lumbar interbody fusion(MIS-PLIF)in the treatment of degenerative lumbar spondylolisthesis.Methods:Forty patients with degenerative lumbar disease(spinal stenosis and lumbar spondylolisthesis)from January 2017 to June 2018 were randomly divided into two groups according to different therapeutic regimens.The experimental group used MIS-PLIF(20 cases)and PLIF group(20 cases).The differences of the perioperative clinical data,VAS and ODI before surgery,at 3 days,3 months,6months and 12 months after surgery between the two groups were compared.Results:The intraoperative blood loss,postoperative drainage volume,postoperative time to ambulation,and hospitalization time in the MIS-PLIF group were all significantly lower than those in PLIF group(all P<0.01).The VAS of lumbago and leg pain and ODI in MIS-PLIF group and PLIF group at each postoperative time point were significantly lower than those before surgery(P<0.05),while the VAS of lumbago at 3 day and 3 month after surgery in MIS-PLIF group were significantly lower than that in PLIF group(P<0.05).VAS of lumbago pain and ODI between the two groups at 6 month and 1 year after surgery had no significant difference(P>0.05).VAS of leg pain after surgery had no significant difference(P>0.05).The final follow-up showed that the patient’s symptoms completely disappeared,and the X-ray indication lumbar spondylolisthesis reduction and a strong intervertebral fusion.Conclusions:The clinical efficacy and surgical safety of MIS-PLIF in the treatment of degenerative lumbar spondylolisthesis are comparable to those of traditional open PLIF,but it has the advantages of less intraoperative blood loss,short duration of postoperative immobilization,less drainage,and shorter hospital stay.It can relieve the postoperative pain and improve the quality of life and the confidence of recovery.