TESSYS和TLIF术治疗腰椎间盘突出症临床疗效分析

Effect Comparison of TESSYS and TLIF for Lumbar Disc Herniation

目的探讨TESSYS术治疗单节段腰椎间盘突出的临床疗效及安全性。方法选择2016年4月～2017年4月在我院治疗的腰椎间盘突出症患者120例,随机分为两组,每组60例,分别行TESSYS手术和TLIF手术。记录术中出血量、手术时间和住院时间等,比较两组患者并发症发生情况及日本骨科协会(JOA)评分、疼痛视觉模拟(VAS)评分、Oswestry功能障碍(ODI)指数变化。末次随访时采用改良MacNab标准评估临床疗效。结果两组手术过程顺利,无一例中转开放手术。同TLIF组相比,TESSYS组手术时间缩短,术中出血减少,住院时间缩短,差异均有统计学意义(P <0. 05)。术后2周和3个月TESSYS组腰腿痛VAS评分优于TLIF组(P <0.05),至术后12个月两组比较差异无统计学意义(P>0.05)。术后3个月和12个月TESSYS组ODI和JOA评分明显优于TLIF组(P <0. 05)。两组术后12个月MacNab评级比较无统计学差异(P> 0. 05)。术后两组均无一例出现定位错误、神经根损伤、椎间隙感染等严重并发症。TESSYS组术后出现下肢暂时性肢体感觉异常2例,髓核残留导致症状仅部分改善2例。TLIF组融合良好,融合时间平均8. 56(6～12)个月,术后硬脊膜破裂2例,切口感染2例,急性尿潴留2例,肢体无力2例。两组并发症率比较,差异无统计学意义(6. 7%vs. 13. 3%,P> 0. 05)。结论 TESSYS术能缩短病人留院时间、减少手术失血量、加快康复速度,促使患者更快地恢复正常活动。术前应根据患者病情选择个性化手术方案,以保障安全和疗效。

Objective To investigate the clinical efficacy and safety of transforaminal endoscopic spine system(TESSYS)for single-stage lumbar disc herniation. Methods A total of 120 patients with lumbar disc herniation admitted in our hospital from April 2016 to April 2017 were divided randomly into 2 groups according to the random number table,with 60 cases for each group.TESSYS surgery was performed in group TESSYS,and transforaminal lumbar interbody fusion(TLIF)was in group TLIF.The clinical data such as operation time,intraoperative blood loss and hospital stays were recorded.The incidence of complications,Japanese Orthopaedic Association(JOA)score,pain visual analogue(VAS)score,and Oswestry dysfunction(ODI)index were compared between the two groups.At the final follow-up,the modified MacNab standard was used to assess the clinical efficacy. Results The operation was successful without converting to open surgery in the both groups.Compare to group TLIF,the operative time and hospital stays was shorter,and intra-operative blood loss was less in group TESSYS,and all the differences were statistically(P<0.05).The VAS score of low back and leg pain was better in group TESSYS than that in group TLIF at 2 weeks and 3 months after the operation(P<0.05),but there was no significant difference between the two groups at 12 months after operation(P>0.05).The scores of ODI and JOA in group TESSYS were significantly better than those in group TLIF at 3 and 12 months after the operation(P<0.05).No statistical difference was found in the MacNab score between the two groups at 12 months after the surgery(P>0.05).No serious complications such as localization error,nerve root injury and intervertebral space infection were found in the two groups after operation.In group TESSYS,temporary abnormal sensation of lower limbs occurred in 2 cases,and residual nucleus pulposus resulted in partial improvement in 2 cases.All cases achieved good fusion in TLIF group during 6 to 12(mean,8.56)months.Dural rupture,incision infection,acute urinary retention and limb weakness were found in 2 cases respectively.There was no statistical difference in post-operative complication rate between the two groups(6.7%vs.13.3%,P>0.05). Conclusions TESSYS can shorten the hospitalization time,reduce the intra-operative blood loss,accelerate the speed of recovery and promote the normal activity for single-stage lumbar disc herniation.In practice,individualized surgical procedures should be selected according to the patient's condition to ensure safety and efficacy.