Wiltse入路与后正中入路TLIF术式对腰椎间盘突出症患者疗效及CK水平、NRS、ODI评分的影响比较

The curative effect of Wiltse approach and after the middle of the road TLIF operation on patients with lumbar intervertebral disc protrusion and the influence comparison of CK,NRS and the ODI score

目的研究对比Wiltse入路与后正中入路经椎间孔腰椎椎体间融合术(TLIF)术式对腰椎间盘突出症患者的疗效及肌酸激酶(CK)水平、数字分级法(NRS)、功能障碍指数(ODI)评分的影响。方法前瞻性选取2015年2月至2016年2月收治的腰椎间盘突出症患者82例。根据随机数字表法分成观察组和对照组,每组41例。所有患者均采用TLIF术式治疗,其中对照组患者采用后正中入路,观察组患者采用Wiltse入路。分别对比两组患者各项临床指标水平,手术前后CK水平、NRS评分、ODI评分以及视觉模拟(VAS)评分变化情况。结果观察组患者术中失血量以及术后引流量均显著低于对照组,差异均有统计学意义(P<0.05)。术后观察组患者的CK水平以及ODI评分分别为(163.5±23.8)U/L、(23.4±2.6)分,均显著低于对照组的(407.5±38.6)U/L、(27.9±4.9)分,差异均有统计学意义(P<0.05)。术后观察组患者腰痛、下肢疼痛以及下肢麻木的NRS评分均显著低于对照组,差异均有统计学意义(P<0.05)。术后观察组与对照组患者的VAS评分分别为(1.5±0.4)分、(2.1±0.7)分,均显著低于术前,而观察组又显著低于对照组,差异均有统计学意义(均P<0.05)。结论 Wiltse入路TLIF术式治疗腰椎间盘突出症患者的疗效更加显著,有利于改善患者的CK水平,缓解临床症状,同时促进患者脊柱功能的恢复,有效减轻疼痛。

Objective To study the curative effect of Wiltse approach and after the middle of the road TLIF operation on patients with lumbar intervertebral disc protrusion and the influence comparison of creatine kinase（ CK）,digital classification method（ NRS）,and the dysfunction index（ ODI） score. Methods From February 2015 to February 2016 in our hospital,82 cases of patients with lumbar disc prolapse were selected. According to random number table method,they were divided into observation group and control group,41 cases in each group. Adopt TLIF operation treatment,all patients of control group were treated by posterior midline approach,the observation group were treated by Wiltse approach. The clinical indicators level respectively,CK,NRS score before and after operation,ODI scores and visual analog scores（ VAS） in the two groups were compared. Results The intraoperative blood loss and postoperative flow in observation group were significantly lower than those in the control group,differences were all statistically significant（ P 〈 0. 05）. The patient＇s level of postoperative CK and ODI score（ 163. 5 ± 23. 8）U/L,（ 23. 4 ± 2. 6） points,in observation group,were significantly lower than those in the control group（ 407. 5 ± 38. 6） U/L,（ 27. 9 ± 4. 9）points,with statistically significant differences（ P 〈 0. 05）. Postoperative low back pain,leg pain and numbness of the NRS scores in observation group were significantly lower than those in the control group,the difference had statistical significance（ P 〈 0. 05）. VAS score in observation group and control group patients respectively（ 1. 5 ± 0. 4）,（ 2. 1 ± 0. 7） points,were significantly lower than those before treatment,and observation group was significantly lower than that of the control group,the difference had statistical significance（ P 〈 0. 05）. Conclusion Wiltse approach TLIF has more significant curative effect in patients with surgical treatment of lumbar intervertebral disc protrusion,which can improve the patient＇s level of CK,relieve clinical symptoms,promote the recovery of patients with spinal function at the same time,effectively relieve the pain.