微创经椎间孔腰椎椎间融合术治疗老年腰椎退变性疾病

Minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in elderly

目的：探讨Pipeline可扩张通道辅助下行后路经椎间孔腰椎椎问融合术（minimall yinvasive transforam－inal lumbar interbody fusion，MI—TLIF）治疗老年腰椎退变性疾病的临床疗效。方法：2010年2月～2012年6月．共有46例老年腰椎退变性疾病患者在我院接受腰椎后路经椎间iL减压椎间植骨融合内固定术。其中24例采用Pipeline可扩张通道辅助下行MI—TLIF，男15例，女9例；年龄60—79岁，平均66-3岁；病程6～60个月．平均18．5个月，设为观察组；22例采用传统开放TLIF（conventional open TLIF，CO—TLlF），男10例，女12例：年龄62—75岁，平均67．0岁；病程6～84个月，平均22．6个月，设为对照组。记录并比较两组患者的手术出血量、手术时间、输血量及术后并发症情况。术后1周、3个月及末次随访时采用视觉模拟评分（VAS）、术后3个月和末次随访时采用Oswestry功能障碍指数（ODI）评估两组临床疗效，末次随访时采用Suk标准对椎间融合情况进行评定。结果：两组患者手术出血量、输血量及并发症发生率有统计学意义（P〈0．05），手术时间无统计学意义（P〉0．05）。随访13～26个月，平均18个月，两组患者术后各时间点的VAS及ODI与术前比较均有统计学意义（P〈0．05）：两组术后1周和3个月的VAS评分及术后3个月的ODI比较有统计意义（P〈0．05），末次随访时两组VAS评分及ODI无统计学意义（P〉O．05）。末次随访时观察组植骨融合率为87．5％（21／23例）．对照组为82-8％（18／22），两组比较无统计学意义（P〉0．05）。结论：MI—TLIF治疗老年腰椎退变性疾病能获得与传统开放TLIF手术相似的早期临床疗效，而出血量和并发症更少。

Objectives： To evaluate outcomes of posterior transforaminal lumbar interbody fusion （MI-TLIF） under Pipeline expandable access system for lumbar degenerative diseases in elderly. Methods： From Febru- ary 2010 to June 2012, 46 elderly patients with lumbar degenerative diseases who underwent TLIF by using two different approaches were retrospectively analyzed. All patients were classified into observation group（MI- TLIF group） and control group（conventional open TLIF, CO-TLIF） according to the operative methods. There were 24 cases in observation group including 15 males and 9 females, aged from 60 to 79 years （average, 66.3 years）, and the course of diseases ranging from 6 to 60 months（average, 18.5 months）; 22 cases in con- trol group including 10 males and 12 females, aged from 62 to 75 years（average, 67.0 years）, and course of diseases ranging from 8 to 64 months（average, 22.6 months）. The blood loss, operation time, amount of blood transfusion and postoperative complications were compared. The clinical outcomes of both groups were evalu- ated by using the VAS（at postoperative 1 week, 3 months and the final follow-up） and ODI（at postoperative 3 months and the final follow-up）, respectively. The bony fusion of both groups were assessed by the Suk stan- dard at the final follow-up. Results： There were significant differences on blood loss, amount of blood trans- fusion and postoperative complications （P〈0.05）, but no significant difference on operation time between MI- TLIF group and control group（P〉0.05）. All patients were followed up for an average of 18 months（range, 13 to 26 months）. The VAS and ODI of both groups at each time point postoperatively experienced improvement compared with the preoperation （P〈0.05）. There were significant differences on VAS score at 1 week and 3 months and the ODI at 3 months respectively, but no differences was noted at the final follow-up between 2 groups（P〈0.05）. The bony fusion rate of MI-TLIF group and control group was 87.5%（21/23 cases） and 82.8% （18/22 cases） at the final follow-up respectively, which showed no statistical significance（P〉0.05）. Conclusions： MI-TLIF has similar surgical outcome with CO-TLIF for lumbar degenerative diseases in elderly, but the former has less blood loss and complications than the latter.