M-TLIF与W-TLIF治疗单节段腰椎退行性疾病的效果

Effect of M-TLIF and W-TLIF in treatment of single-level degenerative lumbar disease

目的探讨微创经椎间孔椎间融合内固定(M-TLIF)与Wiltse入路经椎间孔椎间融合内固定(W-TLIF)在治疗单节段腰椎退行性疾病方面的临床效果。方法以2012年6月至2013年6月收治的单节段腰椎退行性患者61例为研究对象,分为M-TLIF组(28例)和W-TLIF组(33例),对临床疗效、椎间融合率及并发症发生情况进行比较。结果两组患者手术时间比较,差异无统计学意义(P>0.05);但M-TLIF组患者手术切口长度更短[(5.0±0.8)cm],术中出血量更少[(89.3±11.2)mL],而手术中X线片透视次数[(47±10)次]和手术费用[(6.6±1.1)万元]明显高于W-TLIF组患者的(7±2)次和(4.8±0.9)万元,差异均有统计学意义(P<0.05)。M-TLIF组术后切口处视觉模拟评分(VAS)得分和随访腰痛VAS得分优于W-TLIF组,其他评分差异无统计学意义(P>0.05);两组患者的椎间融合率分别为84.9%、85.7%,差异无统计学意义(P>0.05)。结论 M-TLIF和W-TLIF都是治疗单节段腰椎退行性疾病的有效手段,但M-TLIF其手术切口长度更短,术中出血量更少,有效改善术后的腰痛程度;而W-TLIF其X线透视次数少,手术费用相对更低廉。

Objective To investigate the clinical effect of M-TLIF and W-TLIF in the treatment of single segment lumbar degenerative disease.Methods From June 2012 to June 2013,61 patients with single segment lumbar degenerative lumbar spine were treated as the research objects,which were divided into M-TLIF group （28 cases） and W-TLIF group （33 cases）,the clinical efficacy,interbody fusion rate and complications were compared.Results Difference of two groups in operation time were not significantly different （P〉0.05）,but the length of incision of the M-TLIF group was significantly shorter[（5.0±0.8）cm],the amount of bleeding was significantly less[（89.3±11.2）mL],the number of X-ray（47±10） and operation cost[（6.6±1.1）thousand-yuan] were significantly higher than that in W-TLIF group （P〈0.05）.Scores of VAS and VAS of followed up were better than W-TLIF group,the differences of other scores were not statistically significant between the two groups （P〉0.05）.The fusion rates of two groups were 84.9% and 85.7%,the difference was not statistically significant （P〉0.05）.Conclusion Both M-TLIF and W-TLIF are effective methods for treatment of lumbar degenerative disease,but the length of M-TLIF is shorter,the amount of bleeding is less,and the degree of backache is improved,but the number of W-TLIF is less,and the cost is relatively lower.