MiniopenTLIF和openTLIF治疗单节段腰椎间盘突出症的临床研究

Efficacy of minimally invasive TLIF and open TLIF in treating single segmental lumbar intervertebral disc herniation: a comparative study

目的研究微创经椎间孔腰椎椎体间融合术(mini open-TLIF)与开放经椎间孔腰椎椎体间融合术(openTLIF)治疗单节段腰椎间盘突出症的临床疗效。方法 2013年5月—10月行TLIF治疗的50例单节段椎间盘突出症患者中mini open-TLIF组25例,open-TLIF组25例;评价两组的手术时间、术中出血量、术后下地时间、术中透视时间,术前、术后3天、术后3个月、术后6个月、术后1年的VAS评分评估腰腿疼痛情况、ODI评分评估腰椎功能、BSF分级评估椎间融合情况。结果 mini open-TLIF组术手术时间、术中出血量、术后下地时间均优于open-TLIF组,术后3天、术后3个月、术后6个月的VAS、ODI评分均优于open-TLIF组,差异均有统计学意义(P<0.05);末次随诊两组VAS、ODI评分及BSF分级比较差异无统计学意义(P>0.05)。结论微创TLIF治疗单节段腰椎间盘突出具有与开放手术相似的近期疗效,但微创手术创伤小、术后恢复快、椎旁肌损伤轻,早期效果更为满意。

Objective To evaluate the efficacy of minimally invasive TLIF and open TLIF in treating single segmental lumbar intervertebral disc herniation. Method 50 patients admitted to the hospital from May 2013 to October 2013 for treatment of single segmental intervertebral disc herniation with TLIF were firstly divided into two groups,namely,mini open-TLIF group（ n = 25） and open-TLIF group（ n = 25）. The operation time,intraoperative blood loss,postoperative active time,intraoperative fluoroscopy time of both groups were then recorded and evaluated. The VAS scores of both groups as observed3 days before,3 days after,3 months after,6 months after and 12 months after surgery were then used to evaluate the waist and leg pain in both groups. The ODI scores were used to evaluate the lumbar function and the BSF scores were used to evaluate the intervertebral fusion. Findings The mini open-TLIF group were found to work better in operation time,intraoperative blood loss and postoperative activity time than the open TLIF group. Its VAS scores and ODI scores asobserved 3 days before,3 days after,3 months after,6 months after surgery were also better than those of the open-TLIF group. The differences were statistically significant（ P〈0. 05）. The last follow-up found no significant difference between the two groups in VAS and ODI scores and BSF（ P〈0. 05）. Conclusion Minimally invasive TLIF is as efficient as openTLIF in the treatment of single segmental disc herniation. However,it engenders less injury and pain,rapid recovery,minimal invasion,and more desirable early effect.