骶1节段多裂肌劈开入路行MIS-TILF治疗腰椎滑脱症的临床疗效观察

Clinical Observation of MIS-TILF in the Treatment of Lumbar Spondylolisthesis with Sacral Segment 1 Transmultifidus Splitting Approach

目的观察骶1节段多裂肌劈开入路微创经锥间孔腰椎锥间融合术(MIS-TILF)治疗腰椎滑脱症的临床疗效。方法选择2017年2月-2018年2月期间在我院接受治疗的腰椎滑脱症患者98例,按照随机数字表法分为对照组和观察组,每组各49例。给予对照组患者常规正中骶棘肌剥离入路MIS-TILF治疗,给予观察组患者骶1节段多裂肌劈开入路MIS-TILF治疗。比较两组患者治疗前后腰椎功能、术后疼痛情况以及术中出血量、手术时间、术后引流量等手术相关指标。结果两组患者术前的ODI、JOA评分差异无统计学意义(P>0.05);术后,观察组患者ODI评分低于对照组,JOA评分高于对照组,差异具有统计学意义(P<0.05);术前,两组患者的疼痛VAS评分差异无统计学意义(P> 0.05);观察组患者术后3 d、14 d VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组患者术中出血量、手术时间及术后引流量低于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。结论与传统正中骶棘肌剥离入路MIS-TILF治疗比较,骶1节段多裂肌劈开入路MIS-TILF在腰椎滑脱症的治疗中可有效促进患者腰椎功能恢复,同时具有术后疼痛小、术中出血少、术后恢复快等优势。

Objective To observe the clinical efficacy of minimally invasive transcondylar lumbar interbody fusion(MIS-TILF)for the treatment of lumbar spondylolisthesis under the first sacral segment transmultifidus splitting approach.Methods98cases of lumbar spondylolisthesis treated in our hospital between February2017and February2018were selected as the subjects of this study.These patients were divided into the control group and observation group using the random number table method,with49cases in each.The patients in the control group were treated with conventional median iliac spine muscle stripping approach MIS-TILF while those in the observation group were treated with MIS-TILF under the transmultifidus splitting approach.The lumbar function,postoperative pain,intraoperative blood loss,duration of surgery,postoperative drainage,and other surgically related indicators were compared between the two groups before and after treatment.Results There was no significant difference in preoperative ODI or JOA scores between the two groups(P>0.05).After operation,the ODI score of the observation group was lower than that of the control group,but the JOA score was higher than that of the control group.The difference was statistically significant(P<0.05).Before surgery,there was no significant difference in pain VAS scores between the two groups(P>0.05).The VAS scores of the observation group on the3rd and14th days after operation were lower than those of the control group,and the difference was statistically significant(P<0.05).The intraoperative blood loss,duration of surgery,and postoperative drainage were lower or shorter in the observation group than in the control group,so was the length of hospital stay(P<0.05).Conclusion Compared with the traditional median medulla spine muscle dissection MIS-TILF,the MIS-TILF under the transmultifidus splitting approach can effectively promote the recovery of lumbar spine function in the clinical treatment of lumbar spondylolisthesis.The advantages of less pain,less intraoperative blood loss,and faster postoperative recovery can contribute to wider clinical application.