显微镜下椎管减压、椎间融合联合椎弓根螺钉内固定治疗腰椎退行性疾病的围手术期观察

Observation of the perioperative period of lumbar degenerative disease treated by microscope-assisted minimally invasive transforaminal lumbar interbody fusion combined with pedicle screw internal fixation

目的：探讨显微镜下经通道行椎管减压、经椎间孔椎间融合联合经皮椎弓根螺钉内固定治疗腰椎退行性疾病早期临床疗效。方法回顾性分析2012年1月—2015年1月济宁医学院附属滕州市中心人民医院脊柱外科收治并获得随访的60例腰椎退行性疾病患者的临床资料。按手术方式不同分为2组：微创组29例，采用显微镜下椎管减压、经椎间孔腰椎间融合联合经皮椎弓根内固定；传统组31例采用传统后路椎板切除减压融合椎弓根内固定治疗。分别记录2组患者手术时间、围手术期出血量，应用视觉模拟评分（VAS）量表评估术后伤口疼痛程度，记录手术前后 C 反应蛋白（CRP）及肌酸激酶（CK）水平、术后下地活动时间、平均住院时间，记录患者术前及术后1个月、3个月 Oswestry 功能障碍指数（ODI），并进行统计学分析。结果2组患者术前 CRP、CK、ODI 及手术时间比较差异均无统计学意义（P 值均〉0.05）。与传统组比较，微创组术中出血量和术后引流量少，术后1、3、5天切口 VAS 以及术后1天 CRP、CK 水平低，下地活动时间早、住院时间短，差异均有统计学意义（P 值均﹤0.05）。2组患者手术后1、3个月 ODI 比较，差异均无统计学意义（P 值均〉0.05）。结论显微镜下椎管减压、经椎间孔腰椎间融合联合经皮椎弓根螺钉内固定与传统开放手术比较，术后神经功能恢复无差异，且具有出血量少、术后疼痛轻、恢复快及更加微创的优点。

Objective To evaluate the early clinical curative effect of microscope-assisted minimally invasive transforaminal lumbar interbody fusion （MI-TLIF） combined with contralateral percutaneous pedicle screw fixation for lumbar degenerative disease. Methods The clinical data of 60 cases with single-level lumbar degenerative disease treated who were admitted to the Departement of Spine Surgery of Tengzhou Central People′s Hospital from January 2012 to January 2015 were analyzed retrospectively. The patients were treated with microscope-assisted MI-TLIF combined with contralateral percutaneous pedicle screw fixation（minimally invasive group, 29 cases） and traditional posterior lumbar interbody fusion （traditional group, 31 cases）, respectively. A retrospective study was performed to compare the duration of surgery, intraoperative blood loss, postoperative drainage, C-reactive protein （ CRP） and creatine kinase （ CK）. Visual analogy score（VAS） were used for the evaluation of postoperative pain. Average hospitalization days and time of ambulation were also recorded and compared between the two groups. Oswestry disability index （ODI） performed preoperatively and at the first and the third months postoperatively were analyzed for clinical assessment. Results There were no significant differences in preoperative CRP, CK, ODI and the duration of surgery between the two groups （all P values 〉 0. 05）. The minimally invasive group had less blood loss, lower postoperative drainage, lower VAS at postoperative 1 d, 3 d, 5 d, lower CRP level and lower CK level at postoperative 1 d than traditional group（ all P values 〈 0. 05）. The minimally invasive surgery had advantages of rapid recovery and short hospitalizing time. No significant difference was found in ODI in the first and the third months after operation （ all P values 〉 0. 05）. Conclusions MI-TLIF combined with contralateral percutaneous pedicle screw fixation for lumbar degenerative disease not only has no significant differences in the neurologic function recovery, but also has the advantages of less bleeding, mild pain, rapid recovery and minimal surgical trauma.