微创经椎间孔腰椎椎体间融合术单侧置钉与传统TLIF双侧置钉治疗腰椎退行性疾病的前瞻性研究

A prospective study of the treatment of MIS-TLIF with unilateral fixation versus TLIF with bilateral fixation for lumbar degenerative diseases

目的探讨微创经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)单侧置钉与传统TLIF双侧置钉治疗腰椎退行性疾病的疗效差异。方法选择2014-08-2016-08于我院治疗的120例腰椎退行性疾病患者,数字随机法均分为单侧组与双侧组,单侧组患者采用微创TLIF单侧置钉治疗,双侧组采用传统TLIF双侧置钉治疗。结果单侧组术中出血量、手术时间、住院时间均显著低于双侧组,差异有统计学意义(P<0.05);两组手术后疼痛VAS评分、ODI评分均显著低于术前,术后单侧组显著低于双侧组,差异有统计学意义(P<0.05);单侧组椎体融合率为93.33%,双侧组为95.00%,差异无统计学意义(P>0.05);两组术后椎间隙腹侧、背侧、手术侧、手术对侧高度均显著升高,术后单侧组手术侧、手术对侧高度显著高于双侧组,差异有统计学意义(P<0.05),腹侧、背侧差异无统计学意义(P>0.05)。结论 TLIF联合两种置钉治疗均具有较高的椎体融合率,但单侧置钉具有手术时间段、创伤小的优势。

Objective To compare the clinical outcomes of minimally invasive transforaminallumbar interbody fusion （MIS-TILF） with unilateral fixation and TILF with bilateral fixation for lumberdegenerative disease. Methods From August 2014 to August 2016, 120 cases of lumbar degenerativedisease treated in our hospital were selected, and randomly divided into unilateral group and bilateralgroup. The unilateral group was treated with TLIF unilateral fixation, while the bilateral group wastreated with traditional TLIF bilateral fixation. Results The amount of bleeding, operation time andlength of hospital stay in the unilateral group were significantly lower than those in the bilateral group,the differences were statistically significant （P 〈0.05）. The VAS scores and ODI scores of the twogroups after operation were significantly lower than before operation, and the scores of the unilateralgroup were significantly lower than those of the bilateral group after operation, the differences werestatistically significant （P〈0.05）. The vertebral fusion rate of unilateral group was 93.33%, and that ofbilateral group was 95%, the difference was not statistically significant （P〉0.05）. After operation, theheight of intervertebral space, dorsal, surgical side and surgical contralateral of the two groups weresignificantly increased, and the height of surgical side and surgical contralateral of the unilateral groupwere significantly higher than those of the bilateral group, the differences were statistically significant（P 〈0.05）, while there was no significant difference in the height of the ventral and dorsal sidesbetween the two groups （P〉0.05）. Conclusion TLIF combined with two kinds of fixation treatmentboth has a higher rate of vertebral fusion, but unilateral fixation has advantages of less operation timeand less trauma.