Quadrant通道下经椎旁肌间隙入路微创TLIF治疗腰椎管狭窄症

Minimally invasive transforaminal lumbar interbody fusion with Quadrant channel via paraspinal muscle gap approach for lumbar spinal stenosis

目的比较Quadrant通道下经椎旁肌间隙入路(Wiltse入路)经椎间孔腰椎体间融合术(MIS-TLIF)与后正中入路传统TLIF治疗腰椎管狭窄症的疗效及术后并发症。探讨MIS-TLIF治疗腰椎管狭窄症是否具有优势,指导临床上治疗腰椎管狭窄症选择最佳的手术方式。方法选取2017年1月~2018年1月腰椎管狭窄症患者50例,按骨科入院顺序(住院号)采用随机数字表法将其分为两组,分为改良微创TLIF(试验组,25例)及传统TLIF(对照组,25例),其中试验组采用Quadrant通道下经椎旁肌间隙入路(Wiltse入路)经椎间孔腰椎体间融合手术方式,对照组则采用开放式经后正中入路经椎间孔腰椎体间融合手术方式,评价比较两组的手术中出血量、术后引流量、切口长度、手术时间、住院时间、术前及术后1周腰、腿痛疼痛视觉模拟评分(VAS)、日本骨科学会(JOA)评分、JOA改善率及椎间植骨融合情况等差异。结果 50例患者均成功完成手术,两组手术时间、住院时间差异无统计学意义(P> 0.05)。试验组患者术中出血量和术后引流量均显著少于对照组(P <0.05)。对照组术后1周VAS评分高于试验组(P<0.05)。对照组JOA改善率平均为(80.1±13.5)%明显低于试验组(91.2±12.1)%,且试验组术后椎间植骨融合率(96.1±15.3)%明显高于对照组(90.5±16.7)%,差异均有统计学意义(P <0.05)。结论 Quadrant通道下经Wiltse入路MIS-TLIF术式较后正中入路传统TLIF具有手术创伤小、出血量少、患者疼痛轻等优势。Wiltse手术入路可避免严重损伤椎旁肌,防止脊柱不稳,有利于脊柱功能恢复,手术创伤小可有效减轻患者术后疼痛。

Objective To compare the postoperative curative effect and complications between MIS-TLIF(minimally invasive transforaminal lumbar interbody fusion) with Quadrant channel via paraspinal muscle gap approach and the posterior median approach of traditional TLIF for lumbar spinal stenosis. Investigate the advantages of MIS-TLIF for lumbar spinal stenosis and select the best surgical approach for the treatment of lumbar spinal stenosis. Methods Select 50 cases of lumbar spinal stenosis from January 2017 to January 2018.Patients were randomly divided into two groups according to the order of admission to hospital. One group which concluded 25 cases was operated by MIS-TLIF and the other group which concluded 25 cases was operated by traditional TLIF. Compared the difference of the amount of bleeding during operation, postoperative drainage volume, incision length, operative time, hospitalization time, a week before and after surgery of lumbar and leg pain visual analogue scale(VAS), the Japanese Institute of Department of orthopedics(JOA) score, JOA and interbody fusion rate between two groups. Results All 50 patients successfully completed the operation, and there was no significant difference in the two terms of operation time and length of stay(P > 0.05). The intraoperative blood loss and postoperative drainage volume of the experimental group were significantly lower than those of the control group(P <0.05). The VAS score of the control group at 1 week after operation was higher than that of the test group(P <0.05). The average improvement rate of JOA in the control group was(80.1 ± 13.5)%, which was significantly lower than that in the test group(91.2 ± 12.1)%, and the postoperative intervertebral bone fusion rate(96.1 ± 15.3)% in the test group was significantly higher than the control group(90.5 ± 16.7)%, the difference was statistically significant(P < 0.05). Conclusion MIS-TLIF with Quadrant channels via Wiltse approach have many advantages such as little surgical trauma, less bleeding, less pain and so on. Wiltse approach can avoid serious injury to the paraspinal muscles and prevent spinal instability. It is beneficial to the recovery of spinal function.Little surgical trauma can effectively reduce postoperative pain.