MIS-TLIF与PLIF治疗单节段退行性腰椎疾病的疗效比较

Curative effect of minimally invasive surgery transforaminal lumbar interbody fusion and posterior lumbar interbody fusion on single segment degenerative lumbar diseases

目的探讨扩张通道管系统(X-tube)辅助微创经椎间孔路腰椎椎体间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)治疗退行性腰椎疾患的疗效。方法回顾性分析2010年10月-2011年9月我科采用X-Tube辅助MIS-TLIF治疗的单节段退行性腰椎病变患者52例,统计术前1 d、术后3 d、5 d、3个月、6个月、1年腰背痛和下肢痛视觉模拟评分(visual analogue scores,VAS),术前1 d、术后3个月、6个月、1年Oswestry功能障碍指数(Oswestry disability index,ODI),术后1年Nakai疗效评级和Bridwell脊柱融合评级,并与同期行传统开放后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)的38例患者进行比较。结果两组一般资料比较,差异均无统计学意义(P>0.05);术后3 d、5 d、3个月,微创组腰背痛VAS评分低于开放组(P<0.05,其中术后3 d、5 d,P<0.01);其余时间两组间腰背痛和下肢痛VAS评分、ODI评分无统计学差异(P>0.05);两组术后1年Nalai疗效评级和Bridwell脊柱融合评级差异无统计学意义(P>0.05)。结论在治疗退行性腰椎疾病时,MIS-TLIF术式可获得与传统开放PLIF术式相当的治疗效果,且术后短期内腰背痛程度较低。

Objective To study the curative effect of X-tube system-assisted minimally invasive surgery transforaminal lumbar interbody fusion （MIS-TLIF） on degenerative lumbar diseases. Methods Clinical data about 52 patients with single segment degenerative lumbar disease who underwent MIS-TLIF from October 2010 to September 2011 in our hospital were retrospectively analyzed. Their visual analogue score （VAS） of back and leg pain 3 and 5 days, 3 and 6 months, and 1 year after MIS-TLIF, their Oswestry disability index （ODI） 1 day, 3 and 6 months, and 1 year after MIS-TLIF, their Nakai curative effect and Bridwell spinal fusion classification were compared with those of 38 controls after traditional posterior lumbar interbody fusion（PLIF）. Results No significant difference was observed in the general clinical data between the two groups （P ＞ 0.05）. The VAS of back pain was significantly lower in patients 3 and 5 days and 3 months after MIS-TLIF than in those after PLIF （P ＜ O.05）. No significant difference was found in VAS and ODI scores of back and leg pain, and in Nakai curative effect and Bridwell spinal fusion classification between the two groups at other time points （P ＞ 0.05）. Conclusion The curative effect of MIS-TLIF is better than that of PLIF on degenerative lumber disease. The back pain is milder after MIS-TLIF than after PLIF.