MIS-TLIF治疗老年退变性腰椎管狭窄症的临床疗效观察

Clinical efficacy of MIS-TLIF in the treatment of degenerative lumbar spinal stenosis in the elderly

目的比较Quadrant微创通道系统下微创经椎间孔入路腰椎椎体间融合(MIS-TLIF)手术与经后路腰椎椎间融合术(PLIF)手术治疗的临床疗效及安全性。方法选取2013年6月~2017年1月在本院接受治疗的90例退变性腰椎管狭窄症老年患者作为研究对象,其中54例患者采用MIS-TLIF手术(MIS-TLIF组);36例采用PLIF手术(PLIF组)。比较两组患者手术疗效,比较两组患者手术时间、术中出血量、卧床时间、术后输血量、术后引流量等手术指标,比较两组患者术后临床症状改善情况,并比较两组患者不良反应发生情况。结果 MIS-TLIF组手术后痊愈率和总有效率均显著高于PLIF组(P<0.05)。MIS-TLIF组手术时间显著高于PLIF组,术中出血量、卧床时间、术后输血量、术后引流量均显著低于PLIF组(P<0.05)。两组患者术后6个月JOA评分较术前1 d升高,VAS评分、ODI评分均较术前1 d降低(P<0.05)。MIS-TLIF组术后6个月JOA评分较PLIF组术后6个月升高,VAS评分、ODI评分均较PLIF组术后6个月降低(P<0.05)。MIS-TLIF组术后感染发生率、硬囊破裂发生率和总不良反应发生率均显著低于PLIF组(P<0.05)。结论从当前的资料反映出Quadrant微创通道系统下MIS-TLIF手术治疗老年退变性腰椎管狭窄症效果显著、创伤小且恢复快。

Objective To compare the clinical efficacy and safety of minimally invasive surgerytransforaminal lumbar interbody fusion（MIS-TLIF）in Quadrant minimally invasive channel system andconventional posterior lumbar interbody fusion（PLIF）in the treatment of degenerative lumbar spinalstenosis in the elderly. Methods From June 2013 to January 2017 in our hospital for treatment of 90 cases of lumbar spinal stenosis in elderly patients as the research object. Among them,54 patients wereoperated by MIS-TLIF procedure（MIS-TLIF group）,and 36 patients were treated with PLIF operation（PLIF group）. The surgical effects of two groups were compared. The operation time,the amount ofbleeding,the bed time,the amount of blood transfusion and the flow rate after the operation werecompared between the two groups. The clinical symptoms of two groups were compared,and theincidences of adverse reactions in the two groups were compared. Results The cure rate and totaleffective rate in the MIS-TLIF group were significantly higher than those in the PLIF group（P〈0.05）.The operative time in the MIS-TLIF group was significantly higher than that in the PLIF group,and theintraoperative blood loss,bed rest time,postoperative blood transfusion volume and postoperativedrainage volume were significantly lower than those in the control group（P〈0.05）. The JOA score in 6 months after operation in two groups was both higher than that in 1 day before preoperative,VAS scoreand ODI score were lower than these in one day before preoperative（P〈0.05）. The JOA score in the MIS-TLIF group in 6 months after operation was higher than that in the PLIF group in 6 months afteroperation,and the VAS score and ODI score were lower than those in the control group in 6 months afteroperation（P〈0.05）. The incidences of postoperative infection and hard capsule rupture and the totaladverse reaction incidences in the MIS-TLIF group were significantly lower than those in the PLIF group（P〈0.05）. Conclusion MIS-TLIF minimally invasive surgery under Quadrant minimally invasivechannel system for degenerative lumbar spinal stenosis in elderly patients with significant effect,smalltrauma and rapid recovery.