显微镜下MI-TLIF与传统PLIF治疗腰椎退行性疾病的疗效比较

Microscope-assisted minimally invasive transforaminal lumbar interbody fusion versus traditional posterior lumbar interbody fusion in treatment of lumbar degenerative diseases

目的探讨显微镜下经椎间孔腰椎椎间融合、经皮椎弓根钉内固定治疗单节段腰椎退行性疾病的临床疗效。方法回顾性分析自2012-01-2013—09诊治的59例腰椎退行性疾病，采用显微镜下椎管减压、经椎间孔腰椎椎间融合联合经皮椎弓根内固定28例（MI—TLIF组），采用传统后路椎间融合内固定31例（PLIF组）。比较2组手术时间、术中出血量、术后引流量、术后1d肌酸激酶水平，以及术后1年ODI指数、JOA评分及改良Macnab分级。结果所有患者术后均获得平均13（12．14）个月随访。与PLIF组相比，MI—TLIF组术中出血量、术后引流量更少，术后1d肌酸激酶水平更低，差异有统计学意义（P〈0．05）。术后1年2组JOA评分、ODI指数比较差异无统计学意义（P〉0．05）。术后1年2组JOA评分改善率（x^2=1．140，P=0．293）及Macnab优良率（x^2=1．020，P=0．437）差异无统计学意义（P〉0．05）。结论显微镜下椎管减压、经椎间孔腰椎椎间融合、经皮椎弓根钉内固定是治疗单节段腰椎腰椎退行性疾病既安全有效又可达到微创的手术方式。该术式具有手术创伤小、出血量少、近期疗效满意的优点。

Objective To evaluate the clinical effectiveness of microscope-assisted transforaminal lumbar interbody fusion combined with contralateral percutaneous pedicle screw fixation in the treatment of single segmental lumbar degenerative diseases. Methods The clinical data of 59 cases of single segmental lumbar degenerative diseases treated from January 2012 to September 2013 were analyzed retrospect/rely. They were treated respectively with microscope-assisted spinal canal decompression, transforaminal lumbar interbody fusion combined with contralateral pereutaneous pedicle screw fixation in 28 patients（MI-TLIF group） and traditional posterior lumbar interbody fusion in 31 patients（PLIF group）. The duration of surgery, intraoperative blood loss, postoperative drainage, CPK and the Oswestry disability index（ODI） score, lumbar JOA score system and improved Maenab at one year postoperatively were compared between 2 groups. Results The average follow-：up was 13 months（range, 12-14）. The intraoperative blood loss, postoperative drainage volume and the CPK at one day postoperatively in MIS-TLIF group were significantly lower than those in the PLIF group （P 〈0.05）. No significant difference was found in JOA score and the ODI score between the two groups（P 〉0.05）. There were no significant differences in the JOA score improvement rate（x^2 =1 .140, P =0.293） and the excellent and good rate of improved Macnab（x^2=1.020, P =0.437） at one year postoperatively between the two groups. Conclusion It is a safe, effective and minimally invasive operation to apply the method of microscope-assisted ransforaminal lumbar interbody fusion combined with contralateral percutaneous pedicle screw fixation for single-level lumbar degenerative diseases. MIS-TLIF has the advantages of minimal surgical trauma, less bleeding and satisfactory clinical outcome.