两种腰椎后路微创术式治疗腰椎退变性疾病的临床疗效比较

Comparison of the clinical efficacy of two different posterior lumbar spine minimally invasive surgery in the treatment of degenerative lumbar vertebrae

目的探讨两种不同腰椎后路微创术式治疗腰椎退变性疾病的临床疗效。方法 33例腰椎退变性疾病患者分成两组,A组:微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,mini-TLIF)联合小切口(mini-open)置钉18例,为普通螺钉,在MAST Quadrant通道完成mini-TLIF;B组:Mini-TLIF联合经皮(percutaneous pedicle screw fixation,PPF)置钉15例,为中空螺钉,在PIPELINE通道完成mini-TLIF。两组均为单节段,单侧减压椎间融合。分析手术时间、术中出血量、放射线暴露次数及围术期并发症。采用视觉模拟量表(visual analog scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评估临床结果,术前、术后2周及末次随访时评分。结果 31例得到完整随访(A组16例,B组15例),随访时间12～22月。两组均未见神经根损伤症状,术后1年随访固定节段均已骨性融合。A组优良率为100%,B组优良率为93.3%,两组差异无统计学意义。术后2周VAS比较有统计学差异,B组疼痛明显比A组轻。B组的透视次数明显比A组多,而手术时间、术中出血量B组明显比A组少。术后2周ODI评分、随访时VAS评分及ODI评分两组未见明显差异。两组各出现2例切口皮缘坏死变黑;A组发现3例螺钉位置不良及1例硬膜囊撕破,没有神经症状及脑脊液漏。B组1例cage位置不良及1例导丝穿透椎体前缘。结论两种腰椎后路微创术式治疗腰椎退变性疾病均能取得良好的临床疗效,经皮椎弓根螺钉置入术式术中出血量更少,康复时间更短。

Objective To investigate the clinical efficacy of two different posterior lumbar spine minimally invasive surgery in the treatment of degenerative lumbar vertebrae. Methods 33 cases suffering from lumbar degenerative disease were divided into two groups： 18 cases minimally invasive transforaminal lumbar interbody fusion （mini-TLIF） combined with mini-open with ordinary screws and MAST Quadrant as Group A, and 15 cases mini-TLIF through PIPELINE tunnel combined with percutaneous pedicle screw fixation （PPF） with hollow screws as Group B. Both groups were single segment, unilateral decompression, and interbody fusion. The operative time, blooding volume, X-ray exposure time, and perioperative complications were recorded. Visual analog scale （VAS） score and the Oswestry Disability Index （ODI） were used to assess the clinical outcome before operation,2 weeks after operation,and at the end of follow-up. Results 31 cases were followed up 12 to 22 months（16 in Group A cases, 15 cases in Group B）. Both groups showed no symptoms of nerve root injury. The fixed segment after the 1-year follow-up was bony fusion. The good rate was 100% in Group A and 93.3% in Group B, with no significant difference. Two weeks postoperative VAS showed statistical significant difference between the two groups,with much less pain in Group B than in Group A. The X-ray exposure time was significantly more in Group B than in group A, but accompanied with less operative time and bleeding volume. No statistical significance existed in ODI score 2 weeks after surgery and both VAS score and ODI score between the two groups at the end of follow-up. There were two cases of wound superficial skin necrosis in each group. Three cases of screw rnalposition and 1 case of dural tear were observed in Group A,but with no neurological symptoms or cerebrospinal fluid leakage. Whereas one cage position and one guide wire penetrating vertebral occurred in Group B. Conclusion Two different posterior lumbar spine minimally invasive surgery can achieve good efficacy in the treatment of degenerative lumbar vertebrae, but with less blood loss and shorter recovery time for the method of percutaneous pedicle screw placement.