可扩张通道系统下MISS-TLIF手术与开放手术对单节段腰椎滑脱症的治疗

Treatment of single-segment lumbar spondylolisthesis with MISS-TLIF vs open surgery under expandable access system

目的比较可扩张通道系统下微创经椎间孔椎体问融合术（MISS-TLIF）与开放手术治疗单节段Ⅰ-Ⅱ度退行性腰椎滑脱症（DLS）的临床疗效。方法前瞻性分析2014年1月-2015年12月本科室非随机收治的78例单节段Ⅰ-Ⅱ度DLS患者，随机观察组（n=40）与对照组（n=38），观察组采取MISS-TLIF治疗，对照组采取开放手术，比较两组手术相关指标、不同时间点VAS评分、JOA评分、影像学参数及术后1年生活质量评分。结果观察组术中出血量、术后引流量、住院时问及并发症发生率均显著少于对照组（P〈0．05）；与术前比较，两组术后1年VAS评分、滑脱率均显著下降，JOA评分、椎间隙高度均显著上升（P〈0．05）；观察组术后3个月VAS评分、JOA评分分别为（2．21±1．46）分、（23．32±1．25）分，较对照组的（3．82±1．89）分、（18．33±1．76）分差异有统计学意义（P〈0．05）；两组术后1年VAS评分、JOA评分、滑脱率、椎间隙高度比较差异无统计学意义（P〉0．05）。结论可扩张通道系统下MISS-TLIF与开放手术治疗单节段Ⅰ-Ⅱ度DLS影像学效果类似，但前者具有出血量少、术后疼痛轻、并发症少等特点。

Objective To compare the clinical efficacy of minimally invasive surgery of spine-transforaminal lumbar interbody fusion （MISS-TLIF） vs open surgrey for levels Ⅰ - Ⅱ single-segment degenerative lumbar spondylolisthesis （DLS） under an expandable access system. Methods We prospectively analyzed 78 patients with levels Ⅰ - Ⅱ single-segment DLS admitted to our department between January 2014 and December 2015. The patients were randomized to a study group （n=40） and a control group （u=38）. The study group underwent MISS-TLIF while the control group underwent open surgery. Between the two groups, the surgery, VAS scores, JOA scores and imaging at different time points, and quality of life at one year post-surgery were compared. Results The intraoperative blood loss, postoperative drainage, length of hospital stay and incidence of complications in the study group were significantly less than those in the control group （P 〈 0.05）. Compared with before surgery, the both groups had significantly decreased VAS score and slip rate, along with increases in JOA score and intervertebral height at one year after surgery （P 〈 0.05）. The VAS score and JOA score in the study group were （2.21± 1.46） and （23.32± 1.25） points respectively at 3 postoperative months, compared to （3.82± 1.89） and （18.33± 1.76） points, respectively, for the control group, with statistically significant differences （P〈O.05）. There was no significant difference in VAS score, JOA score, slip rate, intervertebral height between the two groups at one year after operation （P〉0.05）. Conclusion MISS-TLIF under expandable access system yields similar imaging outcomes as by open surgery in levels Ⅰ - Ⅱ single-segment DLS. However, the former is associated with less blood loss, postoperative pain, and fewer complications.