导航下微创PLIF与传统PLIF治疗腰椎退变性疾病疗效比较

Comparison of MIS-PLIF and Traditional PLIF for Lumbar Degenerative Diseases by Computer Navigation

目的比较导航下微创腰椎后路椎体间融合术(posterior lumber interbody fusion,PLIF)及导航下传统PLIF治疗单节段病变的腰椎退行性疾病临床效果。方法回顾性分析106例PLIF治疗的单节段腰椎退变性疾病患者,42例采用导航辅助下微创(minimally invasive,MIS)减压、后路椎间融合、经皮椎弓根固定术治疗(A组),其中男24例,女18例;年龄21~72岁,平均54.3岁;病变位于L4~5节段20例,L_5S_1节段22例。64例患者采用导航辅助下传统开放减压、后路腰椎椎体间融合术治疗(B组),其中男33例,女31例;年龄23~74岁,平均56.7岁;病变位于L_(4~5)节段30例,L_5S_1节段34例。比较两组患者手术时间、术中C型臂X线机照射次数、术中出血量、术后引流量及术后并发症,并采用视觉模拟评分(visual analogue scale,VAS)评价治疗效果。结果所有患者均获得随访,两组术后均无感染,无脑脊液漏及神经损伤并发症发生。A组手术时间和术中透视次数多于B组(P<0.05),术中出血量和术后引流量A组明显少于B组(P<0.05)。两组术前VAS评分差异无统计学意义(P>0.05),术后5d、术后2周腰痛VAS评分A组优于B组(P<0.05),但术后12个月左右两组患者腰痛VAS评分差异无统计学意义(P>0.05)。术后腿痛VAS评分,两组差异无统计学意义(P>0.05)。两组术后5d、术后2周及末次随访腰痛和腿痛VAS评分分别与术前比较,差异均有统计学意义(P<0.01)。结论治疗单节段腰椎退行性疾病,导航辅助下微创PLIF与导航辅助下传统开放PLIF均能缓解患者腰痛、腿痛的症状,同样可以获得安全、有效的治疗效果,且导航下微创PLIF比导航下传统PLIF在术后短期内腰痛、手术出血量、术后引流量、术后下床活动时间方面优于开放手术。

Objective To compare the clinical effect on MIS-PLIF by navigation with traditional PLIF by navigation for single segmental lumbar degenerative diseases.Methods Clinical data about 106 patients with single-level lumbar degenerative diseases were retrospectively analyzed in our department from June 2014 to May 2017.42 cases（group A）underwent MIS decompression,posterior lumbar interbody fusion,percutaneous pedicle screw fixation assisted by navigation with average age of 54.3 years old（21~72）.There were 24 males and 18 females,and 20 cases of lesions located in L_（4~5） segments,22 cases of L_5S_1 segments.The other 64 cases（group B）underwent traditional open decompression,posterior lumbar interbody fusion assisted by navigation with average age of 56.7 years old（23~74）.There were 33 males and 31 females,and 30 cases of lesions located in L_（4~5） segments,34 cases of L_5S_1 segments.The operative time,X-ray exposure times,blood loss,postoperative ambulation and complications were compared between two groups.Furthermore,visual analogue scores（VAS）and X-ray examination were used to assess the clinical outcomes.Results All the patients were followed up,and no complications such as infection,cerebrospinal fluid leakage（CSF leak）and nerve injury happened in both groups.Group A had longer operative time and X-ray exposure times than group B（P〈0.05）,but less blood loss during operation and after operation than group B（P〈0.05）.There was no significant difference between the two preoperative VAS scores（P〈0.05）.The VAS scores for low backache at 5 th day and two weeks postoperative in group A was better than group B（P〈0.05）,but the scores was no statistical difference between two groups at 12 months postoperative.No difference for the VAS scores of leg pain was noted between two groups.Additional,there were significant differences（P〈0.01）for the VAS scores of low backache and leg pain between two groups at 5 th day and two weeks and 12 months postoperative compared with preoperative.Conclusion Treatment of single segmental lumbar degenerative disease,navigation assisted MIS-PLIF can alleviate the symptoms of patients with low backache and leg pain as well as open PLIF by navigation.Similarly,both types of surgery can be safely and effectively.In addition,as for the low backache,intraoperative blood loss,postoperative bed time,MIS group is superior than open group.