开放及微创经椎间孔入路椎间融合术后融合节段椎间隙高度及前凸恢复程度的比较研究

Comparison of intervertebral height and lordosis of fusion segment between open-and minimally invasive-transforaminal lumbar interbody fusions

目的比较开放经椎间孔入路椎间融合术(open-transforaminal lumbar interbody fusion,Open-TLIF)及微创TLIF(minimally invasive-TLIF,MIS-TLIF)治疗单节段腰椎退行性疾病术后,融合节段椎间隙高度和前凸角的差异。方法以2013年1月—2016年2月因腰椎退行性疾病行TLIF且符合选择标准的患者作为研究对象;其中,41例采用Open-TLIF(Open-TLIF组),34例采用MIS-TLIF(MIS-TLIF组)。两组患者性别、年龄、体质量指数、疾病类型、病程、病变节段等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组术中出血量、住院时间,手术前后腰部、腿部疼痛视觉模拟评分(VAS)以及Oswestry功能障碍指数(ODI);于术前及术后6个月X线片测量融合节段椎间隙前高度(anterior disc height,ADH)、椎间隙后高度(posterior disc height,PDH)、节段前凸角(segmental lordosis,SL),计算ADH、PDH以及SL手术前后差值。结果Open-TLIF组术中出血量及住院时间均明显大于MIS-TLIF组(t=14.619,P=0.000;t=10.021,P=0.000)。术后切口均Ⅰ期愈合,无早期并发症发生。两组患者均获随访,随访时间Open-TLIF组为6~24个月,平均12.6个月;MIS-TLIF组为6~24个月,平均11.5个月。两组组内术后腰部及腿部VAS评分、ODI均较术前明显改善(P<0.05);组间术前及术后2周、6个月VAS评分及ODI比较,差异均无统计学意义(P>0.05)。影像学检查显示椎间融合良好。两组间术前及术后6个月ADH、PDH、SL比较,差异均无统计学意义(P>0.05);ADH、PDH以及SL手术前后差值比较,差异均无统计学意义(P>0.05)。两组组内术后ADH、PDH、SL均较术前明显增加(P<0.05)。结论Open-TLIF和MIS-TLIF治疗单节段腰椎退行性疾病临床疗效及影像学改变均相似,术后椎间隙高度和前凸角均较术前增高;但MIS-TLIF住院时间和术中出血明显减少。

Objective To analyze the restoration of intervertebral height and lordosis of fusion segment after open-transforaminal lumbar interbody fusion(Open-TLIF)and minimally invasive-TLIF(MIS-TLIF).Methods Between January 2013 and February 2016,patients who treated with TLIF due to lumbar degenerative diseases and met the selection criteria were selected as the study objects.Among them,41 patients were treated with open-TLIF(Open-TLIF group),34 patients were treated with MIS-TLIF(MIS-TLIF group).There was no significant difference between the two groups(P>0.05)in gender,age,body mass index,disease type,disease duration,pathological segment,and other general data.The intraoperative bleeding volume,hospital stay,visual analogue scale(VAS)score of waist and leg,and Oswestry disability index(ODI)were recorded before and after operation.The anterior disc height(ADH),posterior disc height(ADH),and segmental lordosis(SL)of fusion segment were measured by X-ray film before and at 6 months after operation.The differences of ADH,PDH,and SL between pre-and post-operation were calculated.Results The intraoperative bleeding volume and hospital stay in Open-TLIF group were significantly higher than those in MIS-TLIF group(t=14.619,P=0.000;t=10.021,P=0.000).All incisions healed by first intention without early complications.All patients were followed up 6-24 months(mean,12.6 months)in Open-TLIF group and 6-24 months(mean,11.5 months)in MIS-TLIF group.The preoperative VAS scores of waist and leg and ODI of the two groups significantly improved(P<0.05).There was no significant difference in VAS scores and ODI between the two groups before operation and at 2 weeks and 6 months after operation(P>0.05).Imaging examination showed the good intervertebral fusion.There was no significant difference in ADH,PDH,and SL between the two groups before operation and at 6 months after operation(P>0.05).The differences of ADH,PDH,and SL between the two groups were not significant(P>0.05).The ADH,PDH,and SL after operation significantly increased in the two groups(P<0.05).Conclusion Open-TLIF and MIS-TLIF show similar effectiveness and radiological change in the treatment of single lumbar degenerative diseases and the improved intervertebral height and lordosis,but MIS-TLIF can significantly reduce hospital stay and intraoperative blood loss.