微创通道经椎间孔椎间融合术治疗单节段腰椎退行性疾病与传统术式的疗效比较

Comparison of the curative effect of minimally invasive transforaminal lumber interbody fusion via channel and traditional operation in treating single-level lumber degenerative disease

目的探讨微创经椎间孔椎间融合术治疗单节段腰椎退行性变与传统术式的疗效比较。方法研究对象为2010年3月-2012年7月间51例手术治疗的腰椎退行性疾病患者。其中15例采用微创小切口通道后路腰椎间融合术（transforaminal lumbar interbody fusion,TLIF）结合微创经皮椎弓根钉内固定系统治疗（MIS-TLIF组）,36例采用常规切口开放经椎间孔椎间融合术治疗（Open-TLIF组）。效果评价包括手术时间、术中及术后出血量、术后住院时间、术后并发症、术后视觉模拟评分法（visual analogue scale/score,VAS）及Oswestry功能障碍指数（oswestry disability index,ODI）,采用Suk标准评价植骨融合率。结果 51例患者均获随访（随访时间为10-20个月,平均13.6个月）。手术时间相似（t=0.386,P=0.702）;MIS-TLIF组术中及术后出血量较少,术后住院时间较短（P0.05）;末次随访时,MIS-TLIF组VAS评分显著低于Open-TLIF组（t=-2.022,P=0.047）。术后3个月及末次随访时,两组间ODI比较差异均无统计学意义（P〉0.05）。随访期间影像学检查显示,两组Cage和内固定物位置良好,植骨融合率均为100%。结论 MIS-TLIF治疗单节段腰椎退变疾患近期疗效与Open-TLIF相当,并具有手术创伤小、术后恢复快的优点。

Objective To explore the clinical efficacy of minimally invasive transforaminal lumber interbody fusion via channel and traditional operation in treating single-level lumbar degenerative disease. Methods From Mar. 2010 to Jul. 2012,51 cases of lumbar degenerative disease were surgically treated,including 15 cases by minimally invasive transforaminal lumbar interbody fusion （TLIF） （MIS-TLIF group）, and 36 cases by conventional open transforaminal treatment （open-TLIF group）. The operative time, intraoperative and postoperative bleeding, postoperative hospital stay, postoperative complications, visual analogue scale/score （VAS） , and Oswestry disability index（ODI） were compared between the two groups. The fusion rate was evaluated with Suk＇s standard. Results All the 51 patients were followed up for 10 to 20 months（ mean 13.6 months）. The results between the two groups showed similar operation time（ t = 0. 386,P = O. 702）. The intraoperative and postoperative bleeding was reduced and the postoperative hospital stay was significantly shorter in MIS-TLIF group（P 〈 0. 05）. There was 1 case of ce- rebrospinal fluid leakage and 1 case of wound infection in open-TLIF group, in which the complication rate was 5.6% （2/36）. There was 1 case of irritation of the dorsal root ganglion symptoms in MIS-TLIF group,in which the complication rate was 6. 7% （ 1/15 ）. There was no statistically significant difference in the incidence of complica- tions between the two groups （ X2 = 0. 567,P = 0. 427） , and no significant difference on VAS scores between the two groups on discharge and 3 months after discharge（ P 〉 0. 05 ）. VAS score was significantly lower at the final follow-up in the MIS-TLIF group than that in the open-TLIF group（t = - 2. 022,P = 0. 047）. At three months ＇after operation and the last follow-up, there was no statistical difference in ODI between the two groups （ P 〉 0. 05 ）. Imaging studies revealed good position of cage and internal fixation in the two groups, with the fusion rate of 100%. Conclusion The clinical efficacy of MIS-TLIF in treating single-segment lumbar degenerative disease is similar to that of open-TLIF, which has advantages of minimal trauma and fast postoperative recovery.