微创与开放经椎间孔腰椎椎间融合术治疗腰椎退变性疾病的临床对照研究

Clinical control study on MiTLIF and open - TLIF for treatment of lumber degenerative diseases

目的回顾性分析微创（MiTLIF）和常规开放经椎间孔腰椎椎间融合术（TuF）治疗腰椎退变性疾病的临床效果。方法回顾性分析2010年3月至2012年6月四川省人民医院神经外科手术治疗腰椎退变性疾病患者75例，按手术方法，分为MiTLIF组32例，开放TLIF组43例。MiTLIF组均采用可扩张通道（Quadrant）和经皮椎弓根螺钉（Sextant）技术。收集分析比较两组的手术时间、术中出血量、住院时间和并发症。采用视觉模拟量表（VAS）评分评估临床结果，腰椎动力位X线片和薄层CT扫描重建检查评价椎问融合情况。结果MiTLIF组的总的手术并发症率为19％（6／32），开放组21％（9／43），P=0．12。手术时间在MiTLIF组为（1．5i0．3）h，开放组为（1．6±0．5）h，P=0．56。术中出血量在MiTLIF组为（136．0±43．0）ml，开放组为（292．0±112．0）rnl，P〈0．0001。平均住院时间在MiTLIF组为（4．5±2．7）d，开放组为（7．2±4．6）d，P=0．0015。术前与术后腰腿痛VAS评分的平均变化（5．4与5．2，P=0．9）。末次随访MiTLIF组椎间融合率为94％（30／32），开放组为98％（42／43），P=0．22。结论采用MiTLIF技术治疗腰椎退行性疾病可以达到与开放TLIF相同的治疗效果，且出血更少，住院时间更短，严重的手术并发症更低。

Objective To investigate the clinical outcomes and complications of minimally invasive transforaminal lumber interbody fusion （MiTLIF） and open -TLIF for lumber degenerative diseases. Methods Between March,2010 and June,2012, 75 patients of lumber degenerative diseases were operated in neurosurgical department of Sichuan Provincial People, s Hospital. MiTLIF and open -TLIF was performed in 32 and 43 patients, respectively. MiTLIF was done by using expandable working tubes （Quadrant） and percutaneous pedicle screws （Sextant）. Operative time, intraoperative blood loss, length of hospital -stay,and complications were collected. Visual analog scale（VAS） scores were recorded to evaluate clinical outcomes. Interbody fusion was evaluated via dynamic radiographs, and with thin CT scan reconstructions. Results The total complication rate was 19% （6/32） in the MiTLIF group and 21% （9/ 43 ） in the open - TLIF, P = 0. 12. The operative time was（ 1.5 ±0. 3 ） h for MiTLIF and（ 1.6 ± 0. 5 ） h for open procedures, P = 0. 56. The intraoperative blood loss for the MiTLIF （ 136.0 ± 43.0 ） ml was significantly lower than the open - TLIF（292. 0± 112.0 ）ml, P 〈 0. 0001. The mean length of hospital - stay in the MiTLIF （4. 5 ±2. 7 ）d was significantly shorter than the open -TLIF（7.2 ±4. 6）d, P = 0. 0015. The mean change in VAS scores postoperatively was no statistical difference in the two groups（5.4 vs. 5.2 P = 0. 9 ）. The interbody fusion rate at last follow -up in the MiTLIF group （94% ,30/32 ） was comparable with that in the open - TLIF （ 98%, 42/43 ） , P = O. 22. Conclusions MiTLIF technique may provide equivalent clinical outcomes compared to open - TLIF for lumber degenerative diseases. The benefits of MiTLIF includes reduced blood loss, short length hospital - stay, and decreased severe complications.