两种不同的手术方法治疗复发性腰椎间盘突出症临床疗效比较

A comparative study of the clinical outcomes of 2 different kinds of surgical methods in the treatment of recurrent lumbar disc herniation

目的比较通道下经椎间孔腰椎融合内固定术与开放性腰椎融合内固定术治疗复发性腰椎间盘突出症的临床疗效。方法对2008年1月至2011年3月，我院我科的收治复发性腰椎间盘突出症共67例进行回顾性分析，根据手术方式分为开放组（OTLIF）36例和微创组（MITLIF）31例，2组患者术前年龄、性别、术前JOA评分差异无统计学意义（P〉0．05），具有可比性。OTLIF组采用了传统的开放性腰椎融合内固定术治疗，MITLIF组采用通道下经椎间孔腰椎融合内固定术。比较2组患者的手术时间、术中术后出血量、住院时间、术中术后并发症、术后1、3个月和1年JOA评分（JapaneseOrthopaedicAssociationScores）及1年以后椎间融合率。结果所有患者均获得随访，随访时间为14—46个月，平均27．3个月，MITLIF组的术中术后出血量（193．4±43．5）ml、术后住院时间（13．5±1．8）天、术后2周JOA评分（15．3±1．6），OTLIF组出血量（454．1±79．4）ml、术后住院时间（6．8±2．1）天、术后2周JOA评分（19．5±1．9），两组差异具有统计学意义（P〈0．05）.2组手术时间，术中术后并发症发生率，术后1、3个月和1年JOA评分及腰椎融合率的差异无统计学意义（P〉0．05）.结论通道下经椎间孔微创腰椎融合内固定术治疗复发型腰椎间盘突出症较传统开放式经椎间孔腰椎融合术具有出血少、住院时间短、术后恢复快等优点，能取得较好的早期临床疗效，但两组的中期疗效相当。

Objective To compare the clinical outcomes of through-channel transforaminal and open lumbar interbody fusion and internal fixation in the treatment of recurrent lumbar disc herniation. Methods The data of 67 patients with recurrent lumbar disc herniation who were adopted from January 2008 to March 2011 were retrospectively analyzed. All patients were divided into 2 groups according to the surgical methods, including 36 patients undergoing open transforaminal lumbar interbody fusion （ OTLIF ） and 31 patients undergoing minimally invasive transforaminal lumbar interbody fusion （ MITLIF ）. The differences in age, gender, Japanese Orthopedic Association （ JOA ） scores preoperatively between the 2 groups were not statistically significant （ P〉0.05 ）, indicating that they are comparative. The patients in the OTLIF group were treated with traditional open lumbar fusion and internal fixation, and the patients in the MITLIF group were treated with through-channel transforaminal lumbar fusion and internal fixation. The operation time, intraoperative and postoperative blood loss, length of hospital stay, intraoperafive and postoperative complications, JOA scores 1, 3 and 12 months after the operation and intervertebral fusion rates 1 year after the operation were compared between the 2 groups. Results All patients were followed up for a mean period of 27.3 months （ range; 14-46 months ）. In the MITLIF group, the intraoperative and postoperative blood loss was （ 193.4±43.5 ） ml. The duration of postoperative hospital stay was （ 13.5±1.8 ） days. 2 weeks after the operation, the JOA score was （ 15.3±1.6 ）. In the OTLIF group, the blood loss was （ 454.1±79.4 ） ml. The postoperative duration of hospital stay was （ 6.8±2.1 ） days. 2 weeks after the operation, the JOA score was （ 19.5±1.9 ）. The differences between the 2 groups were statistically significant （ P〈0.05 ）. The differences in operation time, intraoperative and postoperative incidences of complications, JOA scores 1, 3 and 12 months after the operation and lumbar fusion rates between the 2 groups were not statistically significant （ P〉0.05 ）. Conclusions The through-channel MITLIF and internal fixation has the advantages of less blood loss, shorter hospitalization time and rapid postoperative recovery in the treatment of recurrent lumbar disc herhiation, with better early-term clinical outcomes when compared with the traditional open TLIF. However, the medium-term results are similar between the 2 groups.