单侧与双侧微创经椎间孔入路腰椎椎间融合手术治疗腰椎退行性疾病的比较

Clinical application of MIS-TLIF combined with unilateral pedicle screw fixation in lumbar degenerative disease

目的探讨微创经椎间孔入路腰椎椎间融合(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)手术治疗腰椎退行性疾病过程中,应用单侧椎弓根钉固定的优势。方法回顾性分析自2012-08-2014-08采用MIS-TLIF技术治疗的腰椎退行性疾病70例,其中单侧椎弓根钉固定38例,双侧固定32例,术后随访23-41个月,平均28.6个月。对两组的围手术期指标、手术前后VAS、ODI评分和并发症、椎间融合情况进行对比。结果单侧组手术时间明显短于双侧组,且术中出血量和术后引流量均明显少于双侧组(P<0.05);两组术后的VAS、ODI评分改善情况,以及并发症发生率、椎间融合率均较为相近(P>0.05)。结论在MIS-TLIF术中联合单侧与双侧椎弓根钉固定的疗效相近,但单侧固定的手术创伤更小,术中出血量更少,可优先选择。

Objective To explore the advantage of application of unilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） surgical in the treatment of lumbar degenerative diseases. Methods A retrospective analysis was conducted in 70 cases with lumbar degenerative disease who were treated by MIS-TLIF from August 2012 to August 2014, including unilateral pediele screw fixation in 38 cases, 32 cases of bilateral fixation. The patients were followed up for 23-41 months after operation, an average of 28.6 months. The perioperative indicators, VAS, ODI scores, complications and interbody fusion were compared between the two groups. Results The operation time of unilateral group was significantly shorter than the bilateral group, and the amount of intraoperative bleeding and postoperative drainage of unilateral group were significantly less than those of the bilateral group （P〈0.05）. The postoperative VAS and：ODI scores, and the ~incidence of complications, fusion rate of two groups were similar （P〉0.05）. Conclusion The curative effect of unilateral and bilateral pedicle screw fixation in MIS-TLIF is similar, but the operation of unilateral fixation has less trauma, and less blood loss.