MIS-TLIF与PLIF治疗单节段腰椎退行性疾病的近期效果比较

Comparison of short- term effects of adopting transforaminal lumbar interbodyfusion and posterior lumbar interbodyfusion for treatment of single segment degenerative lumbar diseases

目的比较传统开放性后路腰椎椎间融合术(PLIF)与微创通道(LUXOR)辅助经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗单节段退行性腰椎疾病的疗效。方法选择采用LUXOR通道辅助MIS-TLIF手术治疗的单节段退行性腰椎病变患者34例,回顾性分析手术时间、术中出血量、术后引流量、术后卧床时间和术前及随访时的腰背疼痛视觉模拟评分(VAS)、Oswestry功能障碍评分(ODI)和影像学检查资料,并与同期行传统开放PLIF手术的30例患者进行比较。结果 2组患者性别、年龄、临床诊断、病变节段、术前腰背痛VAS评分和ODI评分差别均无统计学意义(P>0.05)。MIS-TLIF组手术时间长于PLIF组(P<0.05),术中出血量、术后引流量、术后卧床时间及术后3,6月时的VAS评分及ODI评分均明显低于PLIF组(P<0.01)。术后随访影像学显示,所有患者手术节段均在术后半年内获得良好的节段融合。结论与传统PLIF手术比较,MIS-TLIF治疗单节段腰椎退行性疾病具有出血少、术后恢复快、腰背疼痛轻等优点。

Objective To compare the effects of adopting LUXOR system-assisted minimally invasive surgery transforaminal lumbar interbody fusion （MIS-TLIF） and posterior lumbar interbody fusion （PLIF） for treatment of degenerative lumbar diseases. Methods Clinical data about 34 patients with single segment degenerative lumbar disease who underwent MIS-TLIF in our hospital were retrospectively analyzed. The operative time, intraoperative blood loss, postoperative drainage volume, postoperative bedtime were recorded and compared with those of 30 patients with the same disease undergoing conventional open PLIF during the corresponding period. The back pain visual analogue score （VAS）, Oswestry disability index （ODI） score and imaging examination were performed before operation and during follow-up period for each patient. Results There was no significant difference in the gender, age, clinical diagnosis, lesion location, VAS and ODI scores before operation between the two groups （P〉0.05）. The operative time was longer in MIS-TLIF group than in PLIF group（P〈0.05）, and the intraoperative blood loss, postoperative drainage volume, postoperative bedtime were lower in MIS-TLIF group than in PLIF group （P〈0.01）. The back pain VAS scores and ODI scores on 3rd and 6th month after surgery in MIS-TLIF group were lower in PLIF group （P〈0.01） . Radiological follow-up imaging revealed good fusion 6 months after operation in all the patients. Conclusion MIS-TLIF has several advantages over conventional open PLIF, such as less intraoperative blood loss, milder muscle damage, and lighter back pain.