TLIF治疗老年多节段腰椎间盘突出并椎管狭窄症的疗效分析

Efficacy analysis of TLIF in treatment of multi segment lumbar disc herniation with spinal stenosis in the elderly patients

目的分析腰椎后路经椎间孔椎体间融合术(TLIF)治疗老年多节段腰椎间盘突出并椎管狭窄症的临床疗效。方法回顾性分析自2010-02—2014-05诊治的178例老年多节段腰椎间盘突出并椎管狭窄症,采用TLIF治疗89例(观察组),采用椎板间开窗髓核摘除术治疗89例(对照组)。比较2组末次随访时VAS评分、ODI指数、JOA评分,观察复发率、腰椎不稳发生率,以及植骨融合情况。结果 178例均获得随访,随访时间23~26(24.60±3.52)个月。观察组末次随访时腰痛VAS评分、ODI指数和JOA评分较对照组改善明显,差异有统计学意义(P<0.05)。末次随访时观察组JOA评分疗效优良率高于对照组,复发率、腰椎不稳发生率明显低于对照组,差异有统计学意义(P<0.05)。结论 TLIF治疗老年多节段腰椎间盘突出并椎管狭窄症的疗效确切,不但可以解除患者腰腿部疼痛、跛行等症状,恢复腰部及下肢功能,而且可以防止椎间盘突出复发和腰椎不稳发生。

Objective To analyze the clinical effect of transforaminal lumbar interbody fusion （TLIF） in the treatment of lumbar disc herniation with spinal stenosis in the elderly patients retrospectively. Methods A retrospective analysis was performed for 178 elderly patients with multiple segmental lumbar disc herniation and spinal stenosis from February 2010 to May 2014. Eighty-nine cases in the observation group were treated by TLIF while 89 cases in the control group were treated by fenestration discectomy. The VAS score, ODI index and JOA score were compared between the 2 groups, and the recurrence rate, the incidence of lumbar instability and the bone graft fusion were observed at the last follow-up. Results All the 178 patients were followed up for 23-26（24.60±3.52） months. The VAS score, ODI index and JOA score of the observation group were significantly improved compared with the control group at the last follow-up, the difference was statistically significant （P 〈0.05）. The excellent rate of JOA score in the observation group was higher than that in the control group, the recurrence rate and the incidence of lumbar instability in the observation were significantly lower than those in the control group at the last follow-up, the difference was statistically significant（P 〈0.05）. Conclusion TLIF is significantly effective for multiple segmental lumbar disc herniation and spinal stenosis in elderly patients. It can not only relieve the symptoms of low back pain and claudication, recover the waist and lower limb function, but also prevent the recurrence of lumbar disc herniation and lumbar instability.