改良双侧短切口在MIS-TLIF手术治疗双节段腰椎退行性疾病的临床应用

Clinical application of modified bilateral short incision in the treatment of double-segment lumbar degenerative diseases with MIS-TLIF

目的探讨传统单侧长切口与改良双侧短切口行微创经椎间孔腰椎椎体间融合术(Transforaminal lumbar interbody fusion,MIS-TLIF)治疗双节段腰椎退行性疾病的疗效和安全性。方法共纳入2014年9月-2017年9月期间行MIS-TLIF手术治疗的双节段腰椎退行性疾病129例,其中62例采用单侧长切口减压(A组),另67例采用改良双侧短切口减压(B组)。对比两组患者的围手术期指标,腿痛及腰痛的VAS评分、Oswestry功能障碍指数(ODI),以及MacNab疗效满意度和脊柱融合情况。结果①围手术期:与B组相比,A组患者的手术时间、术中出血量和X线透视时间均显著增加(P<0.05);两组住院时间的差异无统计学意义(P>0.05)。②疗效指标:两组患者术后腿痛、腰痛VAS评分和ODI指数均有显著改善(P<0.05),但在术前、术后3 d和最后随访时,两组患者无显著差异(P>0.05);末次随访时,两组在并发症、椎间融合率和MacNab满意度方面,均无显著性差异(P>0.05)。结论在双节段MIS-TLIF手术中,双侧短切口减压可显著减少X线暴露,缩短手术时间、减少出血量,且对疗效无不良影响。

Objective To investigate the efficacy and safety of traditional unilateral long incision and modified bilateral short incision in the treatment of double-segment lumbar degenerative diseases with transforaminal lumbar interbody fusion(MIS-TLIF).Methods A total of 129 patients with double-segment lumbar degenerative disease who underwent MIS-TLIF surgery from September 2014 to September 2017 were enrolled,of whom 62 patients underwent unilateral long incision decompression(group A),and 67 patients received modified bilateral short incision decompression(group B).The perioperative indicators,VAS scores for leg and back pain,Oswestry dysfunction index(ODI),MacNab efficacy satisfaction and spinal fusion were compared between the two groups.Results 1 Perioperative period:compared with group B,the operation time,intraoperative blood loss and fluoroscopy time of group A were significantly increased(P<0.05).There was no significant difference in hospitalization time between the two groups(P>0.05).2 E fficacy indicators:postoperative leg pain,low back pain VAS score and ODI index were significantly improved in both two groups(P<0.05),but there were no significant differences between the two groups before operation,at 3 days after surgery and the last follow-up(P>0.05).At the last follow-up,there were no significant differences in the total incidence of complications,intervertebral fusion rate,and MacNab satisfaction between the two groups(P>0.05).Conclusion In the double-segment MIS-TLIF procedure,bilateral short incision decompression can significantly reduce X-ray exposure,shorten the operation time,reduce the amount of bleeding,and has no adverse effects on the efficacy.