两种入路腰椎融合术治疗腰椎疾病的疗效比较

Comparison effect of two approaches in lumbar fusion

目的：探讨椎旁肌间隙入路和传统后正中入路腰椎融合术治疗腰椎疾病的疗效。方法对184例需手术治疗的腰椎疾病患者按照随机数字表法分为两组,分别接受椎旁肌间隙入路（实验组,91例）和传统后正中入路（对照组,93例）行腰椎融合术。比较两组手术时间、术中失血量、术后引流量、卧床时间、VAS评分、肌酸激酶含量变化、满意度等指标。结果184例患者均获得随访,时间12-38个月。实验组手术时间为（114．8±13．4） min、卧床时间为（2．47±0．48）d,低于对照组的（134．9±24．2） min、（4．41±2．28） d,差异均有统计学意义（P〈0．05）。实验组术中失血量为（146．2±48．4）ml、术后引流量（97．3±17．5）ml,低于对照组的（211．8±52．4）ml、（147．2±45．5）ml,差异均有统计学意义（P〈0．05）。术后及末次随访VAS评分：实验组分别为（2．06±0．43）分和（1．76±0．76）分,对照组分别为（3．26±1．12）分和（3．15±1．15）分,两组均较术前降低（P〈0．05）,实验组较对照组更低（P〈0．05）。术后肌酸激酶实验组为（315．1±91．5）U/L、对照组为（574．5±197．6）U/L,差异有统计学意义（P〈0．05）。术后患者满意率实验组为90．1%高于对照组的79．6%（P〈0．05）。结论椎旁肌间隙入路行腰椎融合治疗腰椎疾病安全、有效,较传统后正中入路创伤小。

Objective To explore the clinical effect of lumbar fusion via vertebra-side muscle clearance and tradition-al posterior approach. Methods The 184 patients who need surgery were divided into two groups randomly. All the patients were received lumbar fusion via vertebra-side muscle clearance approach （91 cases, the experimental group） and traditional posterior approach （93 cases, the control group）. Some parameters like surgical time, perioperative blood volume, postoperative drainage, bed time, changes of creatine kinase （ CK） content, satisfaction,VAS were observed by clinicians. Results All patients received follow-up within 12-38 months. Average surgical time and bed time in experimental group was （114. 8 ± 13. 4） min and （2. 47 ± 0. 48） d, which was lower than control group （134. 9 ± 24. 2） min and （4. 41 ± 2. 28） d, P〈0. 05. For perioperative blood volume and drainage, the figure in experimental group （146. 2 ± 48. 4） ml and （97. 3 ± 17. 5）ml, which was lower than control group （211. 8 ± 52. 4） ml and （147. 2 ± 45. 5）ml,P〈0. 05. VAS in the postoperative and at last follow-up were 2. 06 ± 0. 43 and 1. 76 ± 0. 76 points, respectively, in the test group, and they were 3. 26 ± 1. 12 and 3. 15 ± 1. 15, respectively, in the con-trol group;both groups presented decreases from the preoperative values （ P〈0. 05 ） , with greater decreases in the test group than in the control group （P〈0. 05）. The postoperative CK levels were （315. 1 ± 91. 5）U/L in the test group and （574. 5 ± 197. 6）U/L in the control group, with statistically significant difference （P〈0. 05）. Satisfactory rate in experimental group was 90. 1%, which was higher than control group of 79. 6%（P〈0. 05）. Conclusions It′s more mini-invasive, safe and effective to take the surgery in vertebra-side muscle clearance.