经多裂肌间隙入路治疗单节段腰椎间盘突出合并椎管狭窄症的疗效分析

The comparison analysis of treatment of single segmental lumbar disc herniation combined with lumbar spinal stenosis between the transmultifidus approach and the posterior midline approach

目的通过回顾性对比分析经多裂肌间隙入路治疗单节段腰椎间盘突出合并椎管狭窄症的疗效。方法回顾性对比分析58例手术治疗单节段腰椎间盘突出合并椎管狭窄症的临床资料。根据手术入路不同分成经多裂肌间隙入路手术组(实验组)及经后正中入路手术组(对照组),统计两组的术前术后JOA评分、VAS评分、手术优良率、手术节段融合率、开始置钉时间、术中出血量、术后引流量、手术时间、住院费用、住院时间并进行比较。结果所有手术均顺利完成。两组手术时间、住院费用及住院时间上比较无明显统计学差异(P>0.05);两组术前术后JOA评分及手术优良率、手术节段融合率比较差异无明显统计学意义(P>0.05);实验组术后1周及术后1年的VAS评分明显优于对照组,其开始置钉时间、术中出血量、术后引流量明显少于对照组,两组间差异有统计学意义(P<0.05)。结论经多裂肌间隙入路治疗单节段腰椎间盘突出合并椎管狭窄症具有优良的早期临床疗效,未给患者增加更多的住院费用及延长其住院时间,而且明显减少了开始置钉时间、手术出血量及术后引流量,有效地避免了术后肌源性腰痛的出现,更符合微创手术理念,提高了患者术后生活质量,此方法值得在临床上推广应用。

Objective To evaluate the efficiency of the treatment of the single segmental lumbar disc herniation combined with lumbar spinal stenosis using transmultifidus approach by retrospective comparative analysis. Methods The clinical data of 58 patients with lumbar disc degeneration combined with lumbar spinal stenosis were randomly divided into experimental group and control group, according to the random number method. JOA index, VAS index, the rate of good operation, the fusion rate of the operational segment, the starting time of setting screw, the total blood loss and the time of the operation, the volume of drainage after the operation, the expenditure and the time in the hospital were observed. Results All the operations were completed successfully. The expenditure and the time in the hospital, the time of the operation, JOA index, the rate of good operation and the fusion rate of the operational segment between two groups were not statistically significant（P〉0.05）. The VAS index of the experimental group 1 week and 1 year after the operation were better than that in the control group. The difference of the starting time of setting screw, the total blood loss of the operation, the volume of drainage after the operation between two groups were statistically significant （P〈0.05）. Conclusion The early clinic report of the treatment of the single segmental lumbar disc herniation combined with lumbar spinal stenosis by transmultifidus approach is good. It does not add more hospitalization expense to patients and extend the length of the time in the hospital. It can reduce the starting time of setting screw, the total blood loss of the operation, the volume of drainage after the operation, obviously. It can also avoid the occurrence of the postoperative low back pain which is connected with muscle. The transmultifidus approach conforms to the concept of the minimally invasion.