不同手术方案在腰椎退变性疾病患者中的疗效对比

Clinical Effect of Different Surgery in Patients with Lumbar Degenerative Diseases

目的探讨微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MI-TLIF)联合单侧椎弓根固定在腰椎退变性疾病患者中的疗效,为其临床应用提供参考依据。方法选择60例诊断为腰椎退变性疾病的患者作为研究对象,采用随机数字表法分为观察组与对照组,每组30例。分别给予MI-TLIF联合单侧椎弓根固定治疗及MI-TLIF联合双侧椎弓根固定治疗。比较两组围手术期指标的差异。随访6月,采用下腰痛JOA评分标准评估临床疗效;整理两组患者椎间隙高度进行分析和比较。结果观察组患者术中出血量、手术时间、术后引流时间、术后引流量均低于对照组患者;术后两组患者的白细胞介素-6(IL-6)和C-反应蛋白(CRP)水平较术前均显著升高,且观察组患者变化幅度小于对照组患者,差异具有统计学意义(P<0.05)。两组治疗后2月及6月JOA评分及椎间隙高度较治疗前均有明显改善,差异有统计学意义(P<0.05);治疗后2月及6月JOA评分及椎间隙高度比较差异无统计学意义(P>0.05),且同一时间段两组比较差异无统计学意义(P>0.05)。观察组有效率93.3%,高于对照组的86.7%,但差异无统计学意义(P>0.05)。结论对腰椎退变性疾病患者MI-TLIF联合单侧椎弓根螺钉固定治疗造成的创伤小且疗效显著,值得临床推广应用。

Objective To explore the clinical effect of minimally invasive transforaminal lumbar interbody fusion（ MI-TLIF） combined with unilateral pedicle screw fixation in the treatment of patients with lumbar degenerative disease,and to provide the reference for its clinical application. Methods Sixty patients with lumbar degenerative diseases were included. All patients were divided into observation group and control group randomly. Patients in observation group were given MI-TLIF in combination with unilateral pedicle fixation,and patients in control group were given MI-TLIF in combination with bilateral pedicle fixation. The JOA scoring criteria of lower back pain were adopted to evaluate the clinical effects. The height of intervertebral space was analyzed and compared between the two groups. Results The intraoperative bleeding volume,operation time,postoperative drainage time,and the postoperative drainage volume of the observation group were lower than that of control group（ P〈0. 05）. After operation,the serum levels of IL-6 and CRP of the two groups were significantly higher than before,and the changes of the observation group were less than the control group,and the differences were statistically significant（ P〈0. 05）. Comparing with the preoperative index,the 2-month and 6-month postoperative JOA score and the height of intervertebral space got obviously improved（ P〈0. 05）.But there was no difference between the 2-month and 6-month postoperative JOA score and the height ofintervertebral space in the same group（ P〈0. 05）. And it had no difference between the two groups at the same time（ P〈0. 05）. The effective rate of the observation group and the control group was 93. 3% vs. 86. 7%,and the difference was not statistically significant（ P〈0. 05）. Conclusion It is recommended of MI-TLIF combined with unilateral pedicle screw fixation for the treatment of lumbar degenerative diseases on account of less trauma and significant efficacy,which is worthy of clinical application.