通道辅助下微创经椎间孔椎体间融合术治疗腰椎退行性疾病的疗效观察

Comparison of minimally invasive using a tubular retraction system versus open transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases

目的 探讨通道辅助下微创经椎间孔椎体间融合术（MIS-TLIF）与传统TLIF治疗腰椎退行性疾病的临床疗效.方法 回顾性分析2009年6月至2013年6月武警江西省总队医院骨科治疗的腰椎退变性疾病患者96例,按手术方法随机分为MIS-TLIF组42例;男23例,女19例;年龄（64.4±4.9）岁.传统TLIF组54例;男32例,女22例;年龄（66.5±7.6）岁.MIS-TLIF组采用肌间隙入路可扩张通道辅助下行患侧TLIF手术,结合对侧经皮椎弓根螺钉内固定术;传统TLIF组采用后正中入路开放下行TLIF手术.分析比较两组患者的一般资料及手术时间、术中出血量、术后引流量.采用视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）进行评价.影像学评价采用腰椎正侧位及动力位片和（或）CT扫描评价椎间融合情况.结果 96例患者均顺利完成手术,术中无明显并发症;手术时间MIS-TLIF组[（96±37）min]与传统TLIF组[（83±25） min]比较差异无统计学意义（P＞0.05）;术中出血量、术后引流量MIS-TLIF组与传统TLIF组相比差异有统计学意义（P＜0.05）.所有患者均获随访,MIS-TLIF组随访时间（26±7）个月;传统TLIF组随访时间（27±8）个月;两组术后、末次随访时VAS、ODI评分均较术前差异有统计学意义（P＜0.05）;MIS-TLIF组术后、末次随访VAS评分与传统TLIF组相比差异有统计学意义（P＜0.05）;MIS-TLIF组术后、末次随访ODI评分与传统TLIF组相比差异无统计学意义（P＞0.05）.MIS-TLIF组1例出现融合器移位,无神经症状,传统TLIF组1例出现伤口脂肪液化,两组椎弓根系统无松动及断裂,所有患者椎间融合率为100％,植骨融合时间平均为6.5个月.结论 采用通道辅助下MIS-TLIF技术治疗腰椎退行性疾病可以达到与传统TLIF手术相同的疗效,且出血更少,术后腰背部疼痛减轻,有利于患者恢复.

Objective To compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） using a tubular retraction system with traditional transforaminal lumbar interbody fusion （TLIF） for the treatment of lumbar degenerative diseases.Method From June 2009 to June 2013,a total of 96 patients in Department of Orthopaedics,Armed Police Jiangxi Corps Hospital,suffering from lumbar degenerative diseases were divided into 2 groups randomly.42 patients underwent MISTLIF using a tubular retraction system.There were 23 males and 19 females with the age of 64.4 ±4.9.The preoperative diagnosis included lumbar disc herniation with instability（17 cases）,lumbar spinal stenosis（13 cases）,lumbar degenerative spondylolisthesis（12 cases）.54 patients underwent traditional TLIF.There were 32 males and 22 females with the age of 66.5 ± 7.6.The preoperative diagnosis included lumbar disc herniation with instability （22 cases）,lumbar spinal stenosis （17 cases）,lumbar degenerative spondylolisthesis（15 cases）.The general data,operating time,blood loss and volume of drainage after operation were compared between two groups.VAS,ODI evaluating standards were applied to evaluate the therapeutic effect.The intervertebral fusion were observed by X ray or CT scan.Results All patients underwent surgery safely without severe complication occurred.There was no significant difference in operation time between MIS-TLIF group（96 ± 37） min and TLIF group（83 ± 25） min,P 〉 0.05 ; the blood,volume of drainage after operation in MIS-TLIF group were significantly less than TLIF group （P 〈 0.05）.The follow-up time was（26 ±7） months in MIS-TLIF group and（27 ±8） months in TLIF group.Compared with preoperative parameters,the scores of VAS and ODI were significantly decreased after surgery and at the final follow-up in both groups （P 〈 0.05）.Compared with TLIF group,VAS in MIS-TLIF group of postoperation and the final follow-up were improved,respectively （P 〈 0.05）,but there is no significant difference in ODI score.There occurred cage dislocation with no nerve symptom in MIS-TLIF group in 1 case and fat liquefaction in TLIF group in 1 case.At the follow-up after 6.5 months postoperatively,all the operated segments achieved fusion standard and no internal screw were loose or broken.Conclusion MISTLIF technique could provide less operation trauma,blood lose and achieve the similar satisfied short-term effect as traditional TLIF.