可动式椎间盘镜下经椎间孔椎间融合术治疗腰椎滑脱症快速康复的疗效观察

Study on feasibility of enhanced recovery after surgery combined with mobile microendoscopic discectomy-transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesis

目的探讨可动式椎间盘镜下经椎间孔椎体间融合术（MMED－TLIF）联合快速康复外科（ERAS）治疗腰椎滑脱症的可行性及对术后康复的影响。方法回顾性分析2014年10月1日至2016年7月1日因腰椎滑脱症在天津医院微创脊柱外科接受ERAS联合MMED－TLIF的患者52例，记录患者手术时间、术中出血量、住院时间、不同随访时间腰痛、腿痛视觉模拟评分（VAS）、功能障碍指数评分（ODI）以及并发症等指标，影像学指标包括椎间隙高度及融合率。结果共计纳入52例，平均随访12个月。手术时间（115±30） min；术中出血量（100±35） ml。与术前相比，患者术后24 hVAS腰痛评分[术前（6.3±3.3）分，术后24 h （3.5±2.3）分，P〈0.05]、VAS腿痛评分[术前（7.1±4.2）分，术后24 h （3.1±2.6）分，P〈0.05]及ODI功能障碍指数评分[术前（43.5±9.6）分，术后24 h（ 20.9±7.3），P〈0.05]均明显下降。患者平均住院时间为（4.9±1.3） d；术后平均住院时间（2.1±1.2） d。至末次随访时融合率为92.31%（48/52）。结论MMED－TLIF联合ERAS治疗腰椎滑脱症具有可行性，在不增加手术时间及影响远期疗效的前提下能明显减少术中出血、缩短总住院时间和术后住院时间、改善术后疼痛，促进术后快速康复。

Objective To explore the feasibility of enhanced recovery after surgery （ERAS） combined with mobile microendoscopic discectomy-transforaminal lumbar interbody fusion （MMED-TLIF） in the treatment of lumbar spondylolisthesis and its influence on postoperative rehabilitation.Methods From October 1 2014 to July 1 2016 , a cohort of 52 patients with lumbar spondylolisthesis who received the program of ERAS-MMED-TLIF were retrospectively reviewed in Department of Minimally Invasive Spine Surgery, Tianjin Hospital.The primary outcomes include the operation time, intraoperative blood loss, length of hospital stay, VAS score （low back pain and leg pain） and Oswestry Disability Index （ODI） at different follow-up time and complication.The height of intervertebral space and fusion rate were also recorded as radiographic indicators.Results All cases had an average follow-up of 12 months. The mean operative time was （115±30） min with a mean blood loss of （100±35） ml.Compared with preoperative condition, VAS score of low back pain （6.3±3.3 vs 3.5±2.3, P〈0.05）, VAS score of leg pain （7.1 ± 4.2 vs 3.1 ± 2.6, P〈0.05） and the ODI disability index score （43.5±9.6 vs 20.9±7.3, P〈0.05） at the postoperative 24 h were decreased and the difference was statistically significant.The mean hospitalized time were （4.9±1.3） days with mean postoperative hospital stay （2.1±1.2） days.Fusion rate was 92.31% （48/52） at the last follow-up time.Conclusion ERAS combined with MMED-TLIF is feasible in the treatment of lumbar spondylolisthesis, which can significantly reduce intraoperative bleeding, shorten the total length of stay and postoperative hospital stay, improve postoperative pain and promote rapid rehabilitation of patients after operation without increasing the operation time and influencing the long-term effect, it can be applied in clinical practice.