显微镜辅助下微创与开放经椎间孔腰椎间融合术治疗单节段腰椎退行性疾病的疗效比较

Comparison of microscope-assisted minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar degenerative diseases

背景:微创经椎间孔腰椎椎体间融合术(MIS-TLIF)与开放经椎间孔腰椎间融合术(TLIF)是目前临床上治疗单节段腰椎退行性疾病的两种主要方法。如何既有效减压、可靠融合及固定,又能减少损伤及并发症的发生是临床追求的目标。目的:比较显微镜辅助下MIS-TLIF与TLIF治疗单节段腰椎退行性疾病的临床疗效。方法:回顾性分析2015年8月至2016年10月收治的单节段腰椎退行性疾病患者60例。其中32例采用显微镜辅助下MIS-TLIF治疗(MIS-TLIF组),28例采用TLIF治疗(TLIF组)。记录并比较两组患者手术时间、术中失血量、术后引流量和住院时间,并观察术后并发症发生情况。术前,术后3 d,术后3、12、36个月记录两组患者疼痛视觉模拟评分(VAS)、日本骨科协会评估治疗评分(JOA)及Oswestry功能障碍指数(ODI),并进行比较。末次随访时根据MacNab标准评价疗效。术后3个月及末次随访时采用Suk标准评价腰椎融合情况。结果:两组患者均顺利完成手术,未出现硬膜破裂、神经根损伤、切口感染、融合器移位、下沉、内固定松动等并发症。所有患者均获得随访,随访时间36~42个月,平均随访(38.3±1.4)个月。与TLIF组患者相比,MIS-TLIF组患者手术时间更长,术中出血量、术后引流量均更少,住院时间更短,且差异均有统计学意义(P<0.001)。MIS-TLIF组、TLIF组患者术后各时间点腰痛及腿痛VAS评分、ODI指数均低于,JOA评分均高于术前,且差异均有统计学意义(P<0.001)。术后3 d MIS-TLIF组患者腰痛及腿痛VAS评分、ODI指数均低于,JOA评分高于开放TLIF组患者,且差异均有统计学意义(P<0.05);而术后3、12、36个月,两组患者疼痛VAS评分、JOA评分及ODI指数差异均无统计学意义。末次随访时两组患者优良率及椎间融合情况差异均无统计学意义。结论:与TLIF相比,显微镜辅助下MIS-TLIF具有术中出血少、创伤小、术后康复快、临床疗效确切等优势。

Background:Minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and open transforaminal lum bar interbody fusion(TLIF)are two main methods for the treatment of single segmental lumbar degenerative diseases.How to obtain effective decompression,reliable fusion and fixation and reduce the incidence of injury and complications is the goal of clinical pursuit.Objective:To compare the clinical efficacy of microscope-assisted MIS-TLIF and TLIF for single segmental lumbar degenerative diseases.Methods:Sixty patients with single segmental lumbar degenerative diseases treated from August 2015 to October 2016 were retrospectively analyzed.Among them,32 cases were treated with microscope-assisted MIS-TLIF and 28 with open TLIF.The operation time,intraoperative blood loss,postoperative drainage,hospital stay and postoperative complications were recorded.The visual analogue scale(VAS)scores,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)were evaluated before operation and at 3 d,3 months,12 months and 36 months after operation.The MacNab standard was used to evaluate the clinical efficacy at the last follow-up.Lumbar fusion was evaluated according to Suk criteria at 3 months after operation and at the last follow-up.Results:All the patients smoothly underwent surgery.No serious complications were noted,such as dural rupture,nerve root injury,incision infection,fusion cage displacement,sinking,or loosening of internal fixation.All the patients were follow-up for 36 to 42 months,with an average period of(38.3±1.4)months.MIS-TLIF group had longer operation time,less intraoperative bleeding,less postoperative drainage,longer postopera tive hospitalization time than open TLIF group(P<0.001).The VAS scores of low back pain and leg pain and ODI at each time point after operation were significantly decreased,while JOA score was significantly increased in both groups(P<0.001).On the 3rd day after operation,the VAS scores of low back pain and leg pain and ODI in MIS-TLIF group were significantly lower than those in open TLIF group,but the JOA score was higher than that in open TLIF group(P<0.05).There was no significant difference in the VAS scores,JOA score or ODI between the two groups at 3,12 and 36 months after operation.Neither was the excellent and good rate nor intervertebral fusion at the last follow-up. Conclusions: Compared with open TLIF, microscope-assisted MIS-TLIF has the advantages of less bleeding, smaller trauma, faster recovery and precise clinical effect.