微创与开放经椎间孔腰椎椎间融合术组织创伤相关血清指标的比较研究

COMPARISON OF TRAUMATIC RELATED INDEX IN SERUM BETWEEN MINIMALLY INVASIVE AND OPEN TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR TISSUE INJURY

目的比较微创经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)与开放TLIF治疗腰椎退行性疾病组织创伤相关血清指标差异,分析其意义。方法将2012年5月-11月符合选择标准的60例患者纳入研究,根据患者对手术方式认同度、经济条件等情况确定手术方式,行Quadrant可扩张工作通道下经椎间孔椎管减压、椎间植骨融合、Sextant椎弓根螺钉内固定手术(微创组)及传统开放TLIF手术(开放组)各30例。两组患者性别、年龄、病变类型、病变节段、病程等一般资料比较差异均无统计学意义(P>0.05),具有可比性。分别记录患者手术时间、术中出血量、术后住院时间等;应用疼痛视觉模拟评分(VAS)评估患者术后切口疼痛程度。检测两组患者术前及术后24 hC反应蛋白(C-reactive protein,CRP)浓度及肌酸激酶(creatine kinase,CK)活性;以及术前和术后2、4、8、24 h患者血清中IL-6、IL-10及TNF-α的浓度。结果微创组手术时间、术中出血量、术后住院时间及术后1～3 d切口VAS评分均少于开放组,差异有统计学意义(P<0.05)。两组术前血清CRP浓度、CK活性、IL-6、IL-10及TNF-α浓度比较,差异均无统计学意义(P>0.05);术后24 h,微创组CRP浓度、CK活性及术后各时间点IL-6、IL-10浓度均低于开放组,差异均有统计学意义(P<0.05),两组TNF-α浓度差异无统计学意义(P>0.05)。结论微创TLIF导致的组织创伤及系统炎性反应较开放TLIF轻,对患者造成的手术创伤较小。

Objective To compare the difference of traumatic related index in serum and its significance between minimally invasive transforaminal lumbar interbody fusion（MIS-TLIF） and open TLIF. Methods Sixty patients were enrolled by the entry criteria between May and November 2012,and were divided into MIS-TLIF group（n=30） and open TLIF group（n=30）.There was no significant difference in gender,age,type of lesions,disease segment,and disease duration between 2 groups（P 0.05）.The operation time,intraoperative blood loss,and postoperative hospitalization time were recorded,and the pain severity of incision was evaluated by visual analog scale（VAS）.The serum levels of C-reactive protein（CRP） and creatine kinase（CK） were measured at preoperation and at 24 hours postoperatively.The levels of interleukin 6（IL-6）,IL-10,and tumor necrosis factor α（TNF-α） in serum were measured at preoperation and at 2,4,8,and 24 hours after operation. Results The operation time,intraoperative blood loss,and postoperative hospitalization time of MIS-TLIF group were significantly smaller than those of open TLIF group（P 0.05）,and the VAS score for incision pain in MIS-TLIF group was significantly lower than that of open TLIF group at 1,2,and 3 days after operation（P 0.05）.The levels of CRP,CK,IL-6,and IL-10 in MIS-TLIF group were significantly lower than those in open TLIF group at 24 hours after operation（P 0.05）,but there was no significant difference between 2 groups before operation（P 0.05）.No significant difference was found in TNF-α level between 2 groups at pre-and post-operation（P 0.05）. Conclusion Compared with the open-TLIF,MIS-TLIF may significantly reduce tissue injury and systemic inflammatory reactions during the early postoperative period.