后路经腰椎体间融合术的微创技术改良

Research of modified minimal invasive skills for posterior lumbar interbody fusion

目的:探讨采用一个切口单侧减压加对侧肌间隙入路的微创经椎间孔椎体间融合术(minimal invasive transforaminal lumbarinter bodyfusion,MIS-TLIF)治疗下腰椎疾患的临床疗效。方法:收集本院84例下腰椎退变疾病患者资料,其中53例采用MIS-TILF,31例采用传统后路经腰椎体间融合术(posterior lumbar interbody fusion,PLIF)。分析比较两组手术时间、术中出血量、术中术后并发症、术前和术后1 d肌酸激酶值、术前和末次随访时VAS评分及ODI评分。结果:MIS-TLIF组平均手术时间和术中出血量分别为(131.5±21.0)min、(330.6±57.6)m L;PLIF组为(148.3±27.3)min、(460.1±96.4)m L,两组比较差异有统计学意义(P<0.05)。MIS-TLIF组并发症发生率及感染率显著低于PLIF组(P<0.05)。两组在术前和术后1 d CPK值、术前VAS、ODI评分及末次随访ODI评分方面差异均无统计学意义(P>0.05),但末次随访VAS评分MisTLIF组显著优于PLIF组(P<0.05)。结论:应用单侧减压加对侧肌间隙入路的改良TLIF手术治疗腰椎退变性疾病具有微创、出血少、手术时间短、并发症低、医患辐射少、无需特殊器械等优点,是一种安全有效的微创术式。

Objective：To evaluate the clinical curative effect of minimal invasive transforaminal lumbarinter bodyfusion（ MIS- TLIF） of unilateral decompression combined with eontralateral muscle space approach by one incision for low lumbar disease. Methods：84 patients with low lumbar disease were selected,53 cases received MIS-TLIF,and 31 cases received posterior lumbar interbody fusion（PLIF）. The data including operation time,intraoperative blood loss, operative complications, CPK of pre-operation and one day post-operation,VAS scores and ODI of pre-operation and last visit were compared between two groups. Results：The mean operation time, mean intraoperative blood loss in MIS-TILF group were （131.5 ±21.0）min, （330.6 ±57.6） mL respectively; and （148.3 ±27.3 ） min , （460.1 ± 96.4） mL respectively in PLIF group, the differences between the two groups were significant （P 〈 0.05 ）. The total incidence rate of complications and infection rate in MIS-TLIF group were significantly lower than PLIF group （ P 〈 0. 05）. There were no significant differences between two groups in CPK of pre-operation and one day post-operation, VAS scores of pre-operation, and ODI of pre-operation and last visit（ P 〉 0.05 ）. However,the VAS scores at last in MIS-TLIF significantly better than these in PLIF （ P 〈 0. 05 ）. Conclusion ： MIS-TLIF of unilateral decompression combined with contralateral muscle space approach by one incision for low lumbar disease has advantages of little trauma, less complication, lower bleeding, shorter operation time, lower times of X-ray radiation and no use of special implement, etc,is a safe and effective minimally invasive surgery.