微创经椎间孔椎间融合术联合单侧与双侧内固定技术治疗腰椎退变性疾病的疗效比较

Minimally invasive transforaminal lumbar interbody fusion with unilateral or bilateral pedicle screw fixation for lumbar degenerative diseases

目的：对比分析微创经椎间孔椎间融合术（MIS-TLIF）联合单侧内固定技术与联合双侧内固定技术在治疗单节段腰椎退行性疾病中的临床疗效。方法：回顾性分析2009年10月～2012年1月收治的因单节段腰椎退行性疾病行腰椎后路融合术并获得随访的65例患者。采用METRx-MD辅助下MIS-TLIF手术，其中31例患者采用MIS-TLIF联合单侧内固定技术（单侧组），男性17例，女性14例，平均57.3岁；34例患者采用MIS-TLIF联合双侧经皮内固定技术（双侧组），男性16例，女性18例，平均58.9岁。记录两组患者手术时间、出血量、术后住院天数及并发症情况。采用Oswestry功能障碍指数（ODI）评价腰椎功能情况，采用视觉模拟评分（VAS）分别对术前、术后腰痛及下肢痛进行评分。结果：术后随访18~36个月，平均26.6个月，所有患者术后12个月均获得骨性融合。单侧组手术时间80~145min，平均（101.4±27.2）min，术中出血30~100ml，平均（52.5±39.7）ml，术后住院3~7d，术后平均住院（4.4±1.5）d，1例患者硬膜囊撕裂，1例患者术后腰部切口脂肪液化，切口延迟愈合，术后随访期间腰痛和腿痛VAS评分与ODI评分与术前相比均明显改善。双侧组手术时间120~165min，平均（143.1±22.5）min，术中出血40~200ml，平均（106.3±53.8）ml，术后住院4~10d，术后平均住院（6.6±2.1）d，术后VAS、ODI评分较术前明显改善。两组间各时间点的VAS、ODI评分没有显著差异，但手术时间、出血量及住院时间单侧组优于双侧组。术后均未发现内固定松动、断裂等并发症，术后12个月均获得骨性融合。结论：MIS-TLIF联合单侧或双侧内固定技术在治疗单节段腰椎退变性疾病方面，具有相似的治疗效果，单侧内固定具有手术时间短、出血量少及住院时间短的优势。

Objectives： To assess the surgical outcomes of minimally invasive transforaminal lumbar interbody fusion（MI-TLIF） with unilateral or bilateral pedicle screw instrumentation for one-level degenerative lumbar spine disease. Methods： Between October 2009 and January 2012, a total of 65 patients underwent 1-level MI-TLIF by one surgeon in our hospital. All patients underwent minimally invasive unilateral decompression, interbody fusion and pedicle screw fixation with the assistance of microscopic tubular retractor system（METRx-MD）. 31 patients（17 males and 14 females; average age of 57.3 years） underwent MI-TLIF plus unilateral pedicle screw fixation（group A）, while 34 patients（16 males and 18 females; average age of 58.9 years） underwent MI-TLIF plus bilateral pedicle screw fixation（group B）. Operation time, blood loss, postoperative hospital duration and complications were evaluated. The Oswestry disability index（ODI） score and visual analog scale（VAS） pain score were obtained for all patients 24 hours before operation and at each follow-up. Results： The mean follow-up was 26.6 months, with a range of 18 to 36 months. All patients showed evidence of fusion at 12 months postoperatively. The average operation time was （101.4±27.2）min for group A and （143.1±22.5）min for group B, the average operative blood loss was （52.5±39.7）ml for group A and （106.3±53.8）ml for group B, the average postoperative hospital duration was 4.4±1.5d for group A and 6.6±2.1d for group B, there was significant difference between 2 groups. The average postoperative VAS and ODI scores improved significantly in each group. No significant differences were found between 2 groups with respect to ODI and VAS scores. Conclusions： One-level unilateral pedicle screw instrumented MIS-TLIF provides similar outcomes to that of bilateral, with shorter operation time, less bleeding and shorter hospital duration.