经多裂肌与竖脊肌间隙入路行微创经椎间孔腰椎间融合术的前瞻性研究

A prospective study of minimally invasive surgery transforminal lumbar intgerbody fusion through multifidus and sacrospinal muscular approach

目的探讨经多裂肌与竖脊肌间隙入路行微创经椎间孔腰椎间融合术(MIS-TLIF)治疗腰椎间盘退变性疾病的疗效。方法前瞻性分析2010年4月至2010年10月中山大学附属孙逸仙纪念医院收治的62例腰椎间盘退变性疾病患者的临床资料,采用随机数字表法将患者分为TLIF组(采用后路正中入路TLIF术,30例)和MIS-TLIF组(采用经多裂肌与竖脊肌间隙入路行MIS-TLIF,32例),比较两组患者的一般资料、围手术期情况、视觉模拟评分(VAS)及多裂肌MRI信号的改变。结果 TLIF组、MIS-TLIF组平均手术时间分别为(110 ±20)、(100 ± 35)min/节段(P >0.05);术中平均出血量分别为(420 ± 110)、(300 ± 40)mL(P <0.05);术后平均引流量分别为(360 ± 120)、(40 ± 20)mL/节段(P <0.05)。两组患者术后3、6个月VAS分别与术前比较,差异有统计学意义(P <0.05);对术后3个月VAS进行组间比较,差异有统计学意义(P <0.05)。TLIF组患者手术前后多裂肌 MRI 信号分别为(1.5 ± 0.4)级、(2.5 ± 0.5)级,两者比较,差异有统计学意义(P <0.05);MIS-TLIF 组患者手术前后多裂肌 MRI 信号分别为(1.5 ± 0.5)级、(1.6 ± 0.5)级,两者比较,差异无统计学意义(P >0.05)。结论 MIS-TLIF可减少脊柱后部肌肉损伤,加速腰痛的恢复,近期效果较好。

Objective To evaluate the clinical effects of minimally invasive surgery transforminal lumbar intgerbody fusion（MIS-TLIF） through multifidus and sacrospinal muscular approach for lumbar degenerativedisc diseases.Methods The prospective study involved 62 patients with degenerative lumbar diseases were treated by MIS-TLIF using multifidus and sacrospinal muscular approach or transforminal lumbar intgerbody fusion（TLIF） through posterior approach at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2010 to October 2010.These patients were randomized into TLIF group（n = 30） and MIS-TLIF group（n = 32）.The general information,symptoms of peri-operation period,visual analogue scale（VAS）,and MRI signal changes of multifidus muscles were evaluated.Results The average operation time of the TLIF group and MIS-TLIF group were（110 ± 20）,（100 ± 35） min/segment（P 0.05）,the blood loss were（420 ± 110）,（300 ± 40） mL（P 0.05）,the mean drainage were（360 ± 120）,（40 ± 20） mL/segment（P 0.05）,respectively.The VAS at preoperation,3 and 6 months after operation in two groups were compared respectively,the differences among 3 time points had statistical significance（P 0.05）.The VAS at 3 months after operation,there was significant difference between two groups（P 0.05）.The MRI signal of multifidus muscles at preoperation and postoperation was 1.5 ± 0.4,2.5 ± 0.5 respectively in TLIF group,the differences had statistical significance（P 0.05）.The MRI signal of multifidus muscles at preoperation and postoperation was 1.5 ± 0.5,1.6 ± 0.5 respectively in MIS-TLIF group,the differences had no statistical significance（P 0.05）.Conclusion MIS-TLIF with multifidus and sacrospinal muscular approach provides ideal short-term clinical effects because it can reduce spinal posterior muscles damage and accelerate recovery of low back pain.