单切口Wiltse入路MIS-TLIF治疗腰椎退变性疾病疗效评价

Clinical effect of single incision Wiltse approach and MIS-TLIF in the treatment of lumbar degenerative disease

目的探讨单切口Wiltse入路经椎间孔腰椎间融合术(MIS-TLIF)治疗腰椎退变性疾病的疗效。方法回顾性分析2016年1月-2018年9月收治的98例腰椎退变性疾病患者资料,分别采用单切口Wiltse入路MIS-TLIF手术和传统开放TLIF手术治疗。比较两组手术情况和临床疗效。结果两组手术时间无统计学差异(P>0.05),MIS-TLIF组术中出血量、切口长度、住院时间均显著少于开放TLIF组,差异有统计学意义(P<0.05)。两组患者VAS、ODI评分均明显低于术前(P<0.05),MISTLIF组术后3 d VAS评分显著低于开放TLIF组(P<0.05),但两组术后3个月及1年VAS评分、ODI评分无统计学差异(P> 0.05)。两组患者术后椎间隙高度、腰椎前凸角均明显优于术前(P<0.05),但两组间差异无统计学意义(P>0.05)。结论与开放TLIF相比,单切口MIS-TLIF治疗腰椎退变性疾病患者具有创伤小、术中出血少、手术切口小、住院时间短、住院费用低、术后恢复快、术中内固定器械应用灵活等优点。

Objective To explore the curative effect of single incision Wiltse approach and minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative disease.Methods The clinical data of 98 patients with degenerative disease of lumbar spine from January 2016 to September 2018 were retrospectively analyzed.MIS-TLIF surgery by single-incision Wiltse approach and traditional open TLIF surgery were performed respectively.The surgical conditions and clinical efficacy of the two groups were compared.Results There was no statistically significant difference in operative time between the two groups (P>0.05).The intraoperative blood loss,incision length and hospitalization time in the MIS-TLIF group were lower than those in the TLIF group (P<0.05).The postoperative VAS and ODI scores of two groups were significantly lower than preoperation (P< 0.05).The VAS score of MIS-TLIF group at 3 d after operation was lower than that of open TLIF group (P<0.05).The VAS and ODI scores at 3 months and 1 year after operation had no statistically significant differences between the two groups (P > 0.05).The postoperative height of intervertebral space and segmental lordosis in two groups were significantly higher than preoperation (P < 0.05),but there were no statistically significant differences between the two groups (P > 0.05).Conclusion Compared with open TILF,MIS-TLIF has advantages of less trauma, less blood loss, less incision length, shorter hospitalization time, lower hospitalization cost, faster postoperative recovery and flexible application of intraoperative internal fixation devices in the treatment of lumbar degenerative disease.