单边固定融合与MIS-TLIF治疗腰椎间盘突出症的疗效比较

Comparison of clinical outcomes between unilateral fixation fusion and minimally invasive spine transforaminal lumbar interbody fusion in treating lumbar disc herniation

目的：比较单侧椎间融合椎弓根螺钉内固定与MIS-TLIF术式治疗腰椎间盘突出症的近期临床效果。方法：对2008年6月至2013年3月收治的39例椎间盘突出症患者的临床资料进行回顾性分析,男22例,女17例;年龄45～75岁,平均56.9岁。病变节段：L3,4 3例,L4,5 15例,L5S1 21例。其中21例行单边固定融合术（单边固定融合组）,18例行MIS-TLIF术式（MIS-TLIF组）.比较两组患者的手术时间、失血量、术中透视次数及住院天数。术后随访时定期行影像学检查并记录两组患者VAS、ODI评分,末次随访按改良Macnab标准评定临床疗效。结果：两组患者均顺利完成手术,术中术后无严重并发症。单边固定融合组患者的平均手术时间、透视次数分别为（95±25） min、（4.2±0.4）次,明显少于MIS-TLIF组的（120±35 ） min 及（10.1±3.9）次（P〈0.05）.MIS-TLIF组患者的平均失血量、住院时间分别为（75±45） ml、（7.2±2.2） d,显着低于单边固定融合组的（165±60） ml 及（11.0±3.7） d （P〈0.01）.所有患者获得随访,时间12～45个月,平均29.5个月。术后随访期间的VAS、ODI评分较术前显着改善（P〈0.001）,组间比较差异无统计学意义（P〉0.05）.术后影像学检查提示内固定、融合器在位,术后1年CT图像提示两组患者均获得骨性融合。末次随访时两组患者的Macnab疗效评级差异无统计学意义（P〉0.05）.结论：对于腰椎间盘突出症的治疗,只要适应证选择正确,单边固定融合术与MIS-TLIF均能达到满意的临床效果。

Objective：To compare the short-term clinical outcome between unilateral fixation fusion （ULF） and minimally invasive spine transforaminal lumbar interbody fusion （MIS-TLIF） in treating lumbar disc herniation （LDH）. Methods：The clinical data of 39 patients with LDH were retrospectively analyzed from June 2008 to March 2013. There was 22 males and 17 females, aged from 45 to 75 years old with an average of 56.9 years. Therer were 3 cases in L3,4, 15 cases in L4,5, 21 cases in L5S1. Among them, 21 patients underwent unilateral fixation fusion （ULF group） and 18 underwent minimally invasive spine transforaminal lumbar interbody fusion （MIS-TLIF group）. Operation time, blood loss, the times of radiographic exposure and hospital stay were noted and compared between two groups. Radiograph informations were regularily accessed and VAS, ODI scores were recorded at 3 days and 3, 6, 12 months after operation, respectively. According to modified Macnab criteria, the clinical effects were evaluated at final follow-up. Results：All operations were successful without severe complications. The averaged operative time and the times of radiographic exposure in ULF group [（95±25） min and （4.2±0.4） times] were less than that of MIS-TLIF group [（120±35） min and （10.1±3.9） times]（P〈0.05）. But, the mean blood loss and hospital stay in MIS-TLIF group [（75±45）ml and （7.2±2.2）d]were less than that of ULF group [（165±60）ml and （11.0±3.7）d]（P〈0.01）. All patients were followed up from 12 to 45 months with an average of 29.5 months. The VAS and ODI score had significantly improved during the follow-up and no significant differences were found between two groups at the same time point（P〉0.05）. The postoperative radiographs showed internal fixation position was good. And all patients obtained bone fusion by CT scan at 1 year after operation. There was no significant differences in modified Macnab criteria between two groups at the latest follow-up（P〉0.05）. Conclusion：Favorable short-term clinical effects can be achieved in suitable LDH patients with ULF or MIS-TLIF surgical procedures.