微创与开放性经椎间孔腰椎椎间融合术创伤定量对比研究

Quantitative injury of the minimally invasive transforaminal lumbar interbody fusion compared with an open approach

目的定量评价微创经椎间孔腰椎椎间融合术（MIS-TLIF）与开放性经椎间孔腰椎椎间融合术（TLIF）治疗单节段腰椎退行性疾病时对椎旁肌的损伤程度。方法回顾性分析2013年1月至2015年2月45例采用MIS-TLIF与开放性TLIF治疗的单节段腰椎退行性疾病患者资料,其中采用MIS-TLIF20例（微创组）,采用开放性TLIF25例（开放组）。分别记录并比较两组术前及术后1、3、5 d血清肌酸激酶（CK）和白细胞介素（IL）-6水平,手术时间,术中出血量,术后下地时间,术前、术后12个月疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）。采用MRI测量术前、术后12个月手术节段及邻近节段多裂肌横截面积（Mcsa）。结果所有患者术后均获得14-38个月随访,平均24.4个月。微创组术后1 d血清CK水平及术后1、3 d血清IL-6水平明显低于开放组（P〈0.05）,其余时间点两组血清CK、IL-6水平无统计学差异（P〉0.05）。术后12个月两组各有11例患者进行腰椎MRI检查,微创组无论在手术节段还是邻近节段,Mcsa变化率均显著小于开放组（P〈0.01）。两组手术时间无显著性差异（P〉0.05）,但微创组术中出血量及术后下地时间明显优于开放组（P〈0.05）。两组患者术后12个月VAS、ODI评分较术前有显著改善（P〈0.01）,但两组组间比较无统计学差异（P〉0.05）。结论与开放性TLIF相比,MIS-TLIF治疗单节段腰椎退行性疾病能明显减少椎旁肌损伤和系统炎性反应,术中出血量少,术后康复快,并能获得良好的临床疗效。

Objective To evaluate the injury to the paraspinal muscles quantitatively between minimally invasive transforaminal lumbarinterbody fusion （MIS-TLIF） and open transforaminal lumbar interbody fusion （TLIF） for one-level degenerative lumbar spine disease. Methods FromJanuary 2013 to February 2015, a retrospective study was preformed in 45 patients with one-level degenerative lumbar spine disease,20 patients undergoing MIS-TLIF and 25 patients open TLIF. The levels of creatine kinase （CK） and interleukin 6 （IL-6） in serumbefore operation and at 1, 3 , 5 days postoperatively were recorded, together with operation tme , intraoperative blood loss, postoperative ambulation time,preoperative and postoperative visual analogue scale （VAS） and Oswestry disabilitv index （ODI） scores at 12 months. The multifidus cross-sectional area （Mesa） at the operated and adjacent levels was measured by MRI preoperatively and at 12 months postopera tively. Results All patientswere followed for 24. 4 months （range,14-38 months） on average. T h e levels of CK in serum at 1 day postoperatively and IL-6 at 1,3 days postoperatively rn the MIS-TLIF group were significantly lower than those rn the open TLIF group （P〈 0. 05）,but there was no statistical diference rn CK or IL-6 concentrations between two groups at the other tme points （P〉0. 05）. Eleven patients from each group were evaluated using MRI at 12 months postoperatively. The percentage changes of Mesa rsignificantly smaller than those in the open TLIF group not only at the operative level, but also at the adjacent statistical difference in the operation time between two groups （P〉0. 05）,but both the intraoperative blood k）ss and postoperative ambulation time in the MIS-TLIF group were significantly reduced compared with those in the open TLIF group （P〈0. 05）. The postoperative VAS and ODI scores of two groups at 12 months were better than the preoperative outcomes （P〈0. 01）,but there was no statistical difference betweentwo groups （P 〉 0. 05）. Conclusion Compared with open TLIF, MIS - TLIF may significantly reduce the paraspinal muscle injury andpostoperative systemic inflammatory reactions,minimize the blood loss and shorten the recovery time,and thus achieve excellent clinical ou