微创经椎间孔椎体间融合术与开放手术治疗腰椎滑脱症的疗效比较

Minimally invasive transforaminal lumbar interbody fusion versus posterior open-surgery in treatment of lumbar spondylolisthesis

目的对比分析微创经椎间孔椎体间融合术（mini—opentransforaminal lumbar interbody fusion，mini—TLIF）与常规开放手术治疗腰椎滑脱症的疗效。方法回顾性分析2008年3月至2010年8月手术治疗的49例腰椎滑脱症患者，开放手术组26例，mini—TLIF手术组23例。分别统计两组的手术时间、术中出血量、透视时间、手术前后疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）。根据Macnab标准观察临床疗效，测量两组手术前后的各放射学参数并进行对比分析。结果患者随访9＂-22个月，平均11个月。手术出血量、术后2天与3个月VAS、患者再次手术意愿等指标mini—TLIF手术组均优于开放手术组，且差异有统计学意义（P〈0．05）；开放手术组ODI由术前的31．2％±8．2％降至术后末次随访时的16．1％±6．8％，差值为17．8％±4．2％；微创手术组ODI由术前的34．4％±11．7％降至末次随访时的15.3％±4.3％，差值为19．7％±3．8％，两组的手术前后ODI差值差异无统计学意义（t=0．673，P=0．412）；两组手术时间、透视时间，微创手术组均明显长于开放手术组，且差异有统计学意义（P〈0．05）。结论与常规开放手术相比较，mini—TLIF治疗腰椎滑脱症术中出血较少，术后疼痛轻，但需要较长时间的手术及术者接受较多的放射线暴露。

Objective To compare the clinical results-between minimally invasive transforaminal lumbar （mini-TLIF） and posterior open surgery in treatment of lumbar spondylolisthesis. Methods From March 2008 to August 2010, a total of 49 cases with lumbar spondylolisthesis underwent surgical interven- tion were retrospectively analyzed, including 23 cases with mini-TLIF and 26 with open surgery. Operation time, intra-operative bleeding, and radiation exposure times were recorded. Pre- and postoperative back pain was assessed by visual analogue scale（VAS）, and lumbar function was evaluated by Oswestry disability index （ODI）. The clinical results were assessed by Macnab criterion, and the pre and postoperative radiologic pa- rameters were compared. Results The mean follow-up time was 11 months （ranged, 9-22）. Both groups got good clinical results and satisfactory radiologic parameters. The group of mini-TLIF was superior to the group of open surgery in intra-operative bleeding, VAS of the second day postoperatively and the willingness of re- operation （P〈0.05）. The ODI in the patients with open surgery were decreased from 31.2%±8.2% to 16.1%± 6.8% corresponding to the pre-operation and the final follow-up. The ODI in the patients with mini-TLIF were decreased from 34.4%±11.7% to 15.3%±4.3% corresponding to the pre-operation and the final follow-up. There is no significant difference of the change of ODI between two groups （t=0.673, P=-0.412）. The group of mini-TLIF need more operation time and were exposed to more X-ray when compared to the open surgery group （P〈0.05）. Conclusion Mini-TLIF and open surgery can both get satisfactory clinical outcomes in treatment of lumbar spondylolisthesis. Mini-TLIF was superior to open surgery in intra-operative bleeding and VAS of the second day postoperatively, but it needs more operation time and radiation exposure.