经椎间孔椎体间融合治疗单节段腰椎退行性疾病不同术式的疗效观察

Comparative outcomes of three kinds of transforaminal interbody fusion technique in the treatment of single segment lumbar degenerative disease

目的 对比分析经椎间孔椎体间融合术不同手术方式治疗单节段腰椎退行性疾病的临床疗效。方法 2012年10月至2014年11月浙江省人民医院骨科治疗的单节段腰椎退变性疾病患者67例。病例采用数字表法随机分为3组：通道辅助下微创经椎间孔入路腰椎间融合术（mis－TLIF）组（19例）、微创小切口经椎间孔入路腰椎间融合术（mini－open TLIF）组（25例）、传统经椎间孔入路腰椎间融合术（open TILF）组（23例）。分析比较3组手术时间、术中出血量、术中射线暴露时间、住院费用。疗效评价指标采用Oswestrv功能障碍指数（ODI），疼痛视觉模拟评分（VAS）。结果 mis－TLIF组手术时间长于其他2组（P〈0.05），mini－open TLIF组与open TLIF组比较差异无统计学意义（P〉0.05）；术中出血量：open TLIF组〉mini－open TLIF组〉mis－TLIF组（P〈0.05）；术中射线暴露指标、住院费用：mini－open TLIF组与open TLIF组比较差异无统计学意义（P〉0.05），而两组均优于mis－TLIF组（P〈0.05）。术后2 d VAS评分，mis－TLIF组与mini－open TLIF组比较差异无统计学意义（P〉0.05），而均优于open TLIF组[（3.2±1.6）分、（3.4±1.5）分比（5.8±1.4）分]（P〈0.05）；3组术后ODI评分差异无统计学意义（P〉0.05）。结论 3种TLIF手术均可获得良好的临床疗效。微创TLIF手术较传统开放手术具有创伤小、出血少、术后恢复快等优点；而微创TLIF手术中，mini－open TLIF手术具有术中射线暴露少、住院费用低、学习曲线短的优势，值得在临床推广应用。

Objective To compare the clinical outcomes among three kinds of transforaminal interbody fusion technique in the treatment of single segment lumbar degenerative disease.Methods From October 2012 to November 2014, a total of 67 cases of lumbar degenerative disease of single segment underwent surgical intervention were retrospectively analyzed, including 19 cases by mis- transforaminal lumbar interbody fusion（TLIF）, 25 cases by mini-open TLIF and 23 cases by open TLIF.Blood loss, surgical time, fluoroscopy time and hospital costs were recorded.Pre- and postoperative back pain was assessed with visual analogue scale （VAS）, and lumbar function was evaluated with Oswestry disability index （ODI）.Results mis-TLIF group need more surgical time, fluoroscopy time and more hospital costs when compared to mini-open TLIF group and open TLIF group （P〈0.05）, but no significant difference between mini-open TLIF group and open TLIF group （P〉0.05）. mis-TLIF group tended to lose less blood than mini-open TLIF group（P〈0.05）, and mini-open TLIF group lose less blood than open TLIF group （P〈0.05）. There is no significant difference of the change of ODI among three groups （P〉0.05）. mis-TLIF group and mini-open TLIF group was superior to open TLIF group in VAS of the second day postoperative [（3.2±1.6） scale, （3.4±1.5） scale vs（5.8±1.4）scale]（P〈0.05）. Conclusion mis-TLIF, mini-open TLIF and open TLIF can all get satisfactory clinical outcomes in the treatment of single segment lumbar degenerative disease.mis-TLIF and mini-open TLIF was superior to open TLIF in blood loss, early postoperative recovery.Compared with mis-TLIF, mini-open TLIF reduce the fluoroscopy time and hospital costs, and also has a shorter learning curve.