TLIF与PLIF对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效及安全性比较

Comparison the Clinical Efficacy and Safety of Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion in Treating Patients with Degenerative Lumbar Spondylolisthesis combined with Lumbar Spinal Stenosis

目的:比较经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)与经后路椎体间融合术(posterior lumbar interbody fusion,PLIF)对退行性腰椎滑脱合并腰椎管狭窄患者临床疗效及安全性。方法:选择2013年6月到2015年6月我院收治的90例退行性腰椎滑脱合并腰椎管狭窄患者,随机分为TLIF组和PLIF组,各45例。TLIF组患者给予TLIF治疗,PLIF组患者给予PLIF治疗。记录并比较两组患者手术时间、术中失血量、术后引流量及术后卧床时间。评价并比较两组患者治疗前后视觉疼痛评分(visual analogue scale,VAS)和Oswestry功能不良指数(oswestry disability index,ODI)。记录并比较两组患者治疗后神经根损伤、感染、硬膜囊破裂等并发症发生情况。结果:TLIF组患者的手术时间、术中失血量、术后引流量及术后卧床时间均明显小于PLIF组,均具有显著性差异(P<0.05)。治疗前,两组患者VAS、ODI评分,相比均无显著性差异(P>0.05);治疗后,两组患者VAS、ODI评分均明显小于治疗前,且TLIF组患者的VAS、ODI评分均明显小于PLIF组,均具有显著性差异(P<0.05)。TLIF组患者的并发症发生率明显低于PLIF组,均具有显著性差异(X^2=3.873,P=0.049)。结论:相比于PLIF,TLIF治疗退行性腰椎滑脱合并腰椎管狭窄患者的临床疗效显著,有助于腰椎功能的恢复,并发症发生率较低,值得在临床上推广应用。

Objective： To comparison the clinical efficacy and safety of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in treating patients with degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis. Methods： A total of 90 patients with degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis in our hospital from June 2013 to June 2015 were enrolled in this study. The subjects were divided into TLIF group （n=45） and PLIF group （n=45） randomly. The TLIF group were treated with TLIF, the PLIF group were treated with PLIF. The operation time, intraoperative blood loss, postoperative flow and postoperative time in bed of the two groups were compared. The VAS score and ODI score of the two groups before and after treatment were compared. The complications such as nerve root injury, infection and epidural cyst rupture of the two groups after treatment were compared. Results： The operation time, intraoperative blood loss, postoperative flow and postoperative time in bed of the TLIF group were ignificantly lower than that of the PLIF group （P〈0.05）. There were no significantly differences of the VAS score and ODI score of the two groups before treatment （P〉0.05）. After treatment, the VAS score and ODI score of the two groups were significantly lower than before treatment, and that of the TLIF group were significantly lower than the PLIF group （P〈0.05）. The incidence of adverse reactions after treatment of the TLIF group was significantly lower than that of the PLIF group （XZ=-3.873, P=0.049）. Conclusion： Compared with PLIF, TLIF for patients with degenerative lumbar spondylolisthesis combined with lumbar spinal stenosis have good clinical efficacy and security, can help the recovery of the lumbar fuction, it was worthy clinical application.