后路腰椎椎体间植骨融合术与经椎间孔入路腰椎椎间植骨融合术治疗腰椎退行性病变的近期疗效对比

Comparison of preliminary surgical results between posterior lumbar interbody fusion and transforminal lumbar interbody fusion for degenerative lumbar disease

目的比较后路腰椎椎体间植骨融合术(PLIF)与经椎间孔入路腰椎椎间植骨融合术(TLIF)治疗腰椎退行性病变的近期疗效。方法 62例于我院接受单节段手术治疗的部分腰椎退行性病变患者,其中接受PLIF手术患者34例,接受TLIF手术患者28例。比较两组手术时间、出血量、住院时间、并发症及植骨融合率。手术效果按照视觉疼痛模拟评分(visual analogue scale,VAS)、JOA评分(Japanese orthopaedic association scores,JOA)、Oswestry功能障碍指数(oswestry disability index,ODI)和改良MacNab标准进行评定。结果 PLIF组与TILF组手术时间、出血量比较差异有统计学意义(P<0.01);住院时间和植骨融合率比较差异无统计学意义(P>0.05)。PLIF组和TILF组并发症发生率分别为26.5%(9/34)和14.3%(4/28),TLIF组低于PILF组(P<0.01)。PLIF组和TILF组患者术后随访时间为6个月。两组患者术后各随访时间点腰腿痛VAS评分、JOA评分、ODI指数较术前均明显改善(P<0.01),但PILF组术后1个月内腰痛VAS评分高于TLIF组。PLIF组和TILF组患者末次随访时按改良MacNab标准评定优良率分别为91.8%和87.5%,组间比较差异无统计学意义(P>0.05)。结论单节段PLIF与TILF治疗腰椎退行性病变均可取得满意的近期临床疗效,但TLIF创伤小、出血少、对脊柱稳定性破坏较少。

Objective To compare ihe preliminary clinical efficacy of posterior lumbar interbody fusion（PLIF） and transforminal lumbar interbody fusion（TILF） for degenerative lumbar disease. Methods From March 2013 to February 2014,62 cases of degenerative lumbar disease who received single seg- ment interbody fusion surgery were included in this retrospective study. All patients were divided into 2 groups,including 34 patients underwent PLIF and 28 patients underwent TILF respectively. The factors such as operation time, amount of intraoperative bleeding, hospitalization, complications and fusion rate were compared in this retrospective study. The visual analogue scale（VAS） ,Japanese Orthopedic Associa- tion（JOA） scores,Oswestry Disability Index（ODI） and modified MacNab criteria were employed to evalu- ate the clinical outcomes. Results All the cases underwent the operation successfully. The operation time and amount of intraoperative bleeding in the TLIF group were less than those in the PLIF group （P 〈 0.01 ）, while there were no significant differences in the observation factors such as hospitalization and fu- sion rate between the two groups （ P 〉 0.05 ）. The incidence of complications in the PLIF group was 26.5% （9/34） ,which was more than 14.3% （4/28）of the TILF group（P 〈0.01 ）. After surgery,the pa- tients in both groups were followed up for 6 months. The postoperative VAS scores for back pain and leg pain,JOA scores and ODI at each follow-up time in both groups were significantly improved comparing with the preoperative data（P 〈0. 01 ）. However, the back pain VAS scores in the TILF group were higher than that in the PLIF group within the first month. According to the modified MacNab criteria, the excel- lent and good rates in the last follow-up were 91.8% and 87.5% in the PLIF and TILF group,respective- ly, which showed no significant difference between the groups （ P 〉 0.05 ）. All the cases underwent the op- eration successfully. The operation time and amount of intraoperative bleeding in the TLIF group were less than those in the PLIF group（ P 〈0. 01 ） ,While there were no significant differences in the observation fac- tors such as hospitalization and fusion rate between the 2 groups （P 〉 0.05 ）. The incidence of complications in the PLIF group was 26.5% （9/34） ,which was more than 14.3% （4/28）of the TILF group （P 〈 0.01 ）.After surgery,the patients in both groups were followed up for 6 months. The postoperative back and leg pain VAS scores,JOA scores and OD[ at each follow-up time in both groups were significantly improved comparing with the preoperative data（ P 〈 0.01 ）. However, the back pain VAS scores in the TILF group were higher than that in the PLIF group in the 1 months follow up. According to the modified MacNab cri- teria,the excellent and good rates were 91.8% and 87.5% respectively in the PLIF and TILF group in the last follow-up ,which showed no significant difference between the 2 groups（ P 〉 0. 05 ）. Conclusion The preliminary clinical efficacy of both single segment PLIF and TILF in the treatment of degenerative lumbar disease were satisfactory. However,TLIF maybe a better surgical method with such advantages as less trauma,less blood loss and so on.