肥胖对MIS-TLIF手术治疗腰椎管狭窄症的疗效影响

Influence of obesity on the treatment of lumbar spinal stenosis by MIS-TLIF operation

目的探讨肥胖对微创经椎间孔腰椎椎体间融合术(minimal invasive transforaminallumbar interbody fusion,MIS-TLIF)治疗腰椎管狭窄症的疗效影响。方法纳入2013-09-2015-09采用MIS-TLIF手术治疗的132例腰椎管狭窄症患者,其中肥胖31例,作为肥胖组;非肥胖患者101例,作为非肥胖组。对两组患者的围手术期指标、术后VAS评分和ODI指数、植骨融合情况、手术并发症等指标进行对比。结果两组患者均顺利完成手术,术后6个月和末次随访时的VAS评分、ODI指数均较术前显著改善(P<0.05),但组间对比无显著性差异(P>0.05)。与非肥胖组相比,肥胖组患者的切口较长,手术时间和术中出血量显著增加(P<0.05);其中肥胖组的手术并发症发生率为16.13%,非肥胖组为1.98%,组间差异有统计学意义(P<0.05)。肥胖组椎间融合率为96.77%,非肥胖组为97.03%,两组无显著性差异(P>0.05)。结论肥胖患者行MIS-TLIF手术,其切口长度、手术时间和术中出血量均有增加,且术后并发症发生率偏高,但对总体疗效并无影响。

Objective To investigate the influence of obesity on treatment effect of minimalinvasive transforaminal lumbar interbody fusion （MIS -TLIF） for lumbar spinal stenosis. MethodsFrom September 2013 to September 2015, 132 cases of lumbar spinal stenosis treated by MIS-TLIFoperation were selected, including 31 obese patients （obese group）, 101 non obese patients（non obesegroup）. The indicators of perioperative period, VAS score, ODI index, bone graft fusion and surgicalcomplications were compared between the two groups. Results Two groups of patients completed theoperation successfully. The VAS score and ODI index at 6 months after operation and at the end offollow-up were significantly improved compared with before operation （P 〈0.05）, but there was nosignificant difference between the two groups （P 〉0.05）. Compared with the non obese group, theincision in the obese group was longer, the operative time and intraoperative blood loss increasedsignificantly （P〈0.05）, and the incidence rate of operative complications in obese group was 16.13%,while that in the non obese group was 1.98%. The difference between the two groups was statisticallysignificant （P〈0.05）. At the last follow-up, the rate of interbody fusion was 96.77% in the obese group,and that was 97.03% in the non obese group, there was no significant difference between the twogroups （P〉0.05）. Conclusion The incision length, operation time and intraoperative bleeding volumeof obese patients with MIS -TLIF surgery are increased, and the incidence rate of postoperativecomplications is high, but the overall effect is not affected.