微创经椎间孔腰椎融合术与后路腰椎融合术治疗腰椎间盘突出症的疗效比较

Comparison of the therapeutic effect of minimally invasive transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in the treatment of single-level lumbar disc herniation

目的比较微创经椎间孔腰椎融合术(MIS-TLIF)与后路腰椎融合术(PLIF)治疗单节段腰椎间盘突出症的疗效及其对外周血炎性因子的影响。方法选取海盐县人民医院2016年7月至2018年7月收治的单节段腰椎间盘突出症患者100例,采用随机数字表法分为观察组(n=50)和对照组(n=50),对照组患者行PLIF治疗,观察组患者行MIS-TLIF治疗,比较两组患者手术前后的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)评分及外周血炎性因子水平,观察两组手术指标及并发症发生率、复发率。结果观察组术后1周VAS评分、ODI评分分别为(2.32±0.85)分、(19.46±3.44)分,均低于对照组的(4.41±0.97)分、(25.78±3.63)分,差异均有统计学意义(t=13.485、8.936,均P<0.05);观察组术后1周肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)分别为(2.76±0.49)ng/L、(0.78±0.13)ng/L,均明显低于对照组的(4.68±0.81)ng/L、(1.12±0.17)ng/L,差异均有统计学意义(t=14.341、11.240,均P<0.05);观察组手术时间、卧床时间分别为(109.53±20.37)min、(30.61±3.30)d,均短于对照组的(122.34±30.21)min、(42.87±4.68)d,观察组术中出血量、术后引流量分别为(181.12±40.86)mL、(60.08±11.62)mL,均少于对照组的(306.65±50.38)mL、(218.41±24.46)mL,差异均有统计学意义(t=2.486、15.139、13.684、41.343,均P<0.05);观察组并发症发生率为8.00%(4/50),低于对照组的30.00%(15/50)(χ2=19.512,P<0.05);观察组术后3、6、9个月复发率分别为0.00%、4.00%、8.00%,均低于对照组的6.00%、10.00%、22.00%(χ2=6.186、5.674、7.686,均P<0.05)。结论与PLIF比较,MIS-TLIF治疗腰椎间盘突出症可取得良好效果,可减轻患者的疼痛程度,促进患者腰部功能恢复,减轻炎性反应,降低复发率和并发症发生率。

Objective To compare the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and posterior lumbar interbody fusion(PLIF)in the treatment of single-level lumbar disc herniation,and its influence on inflammatory factors in peripheral blood.Methods From July 2016 to July 2018,100 patients with single-level lumbar disc herniation admitted to the People's Hospital of Haiyan County were selected and divided into observation group(n=50)and control group(n=50)according to random number table method.The patients in the control group were treated with PLIF,while the patients in the observation group were treated with MIS-TLIF.The visual analogue scale(VAS),Oswestry dysfunction index(ODI)scores and the levels of inflammatory factors in peripheral blood were compared between the two groups before and after operation.The recurrence rate,incidence of complication and surgical indicators were observed.Results The VAS and ODI scores at postoperative 1 week in the observation group were(2.32±0.85)points and(19.46±3.44)points,respectively,which were lower than those in the control group[(4.41±0.97)points and(25.78±3.63)points],the differences were statistically significant(t=13.485,8.936,all P<0.05).The tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)levels in the observation group at postoperative 1 week were(2.76±0.49)ng/L and(0.78±0.13)ng/L,respectively,which were lower than those in the control group[(4.68±0.81)ng/L and(1.12±0.17)ng/L],the differences were statistically significant(t=14.341,11.240,all P<0.05).The operation time and bed-rest time in the observation group were(109.53±20.37)min and(30.61±3.30)d,respectively,which were shorter than those in the control group[(122.34±30.21)min and(42.87±4.68)d],and the intraoperative blood loss and postoperative drainage volume in the observation group were(181.12±40.86)mL and(60.08±11.62)mL,respectively,which were lower than those in the control group[(306.65±50.38)mL and(218.41±24.46)mL],the differences were statistically significant between the tuo groups(t=2.486,15.139,13.684,41.343,all P<0.05).The incidence of complications in the observation group was 8.00%(4/50),which was lower than 30.00%(15/50)in the control group(χ2=19.512,P<0.05).At 3,6 and 9 months after operation,the recurrence rates in the observation group were 0.00%,4.00%and 8.00%,respectively,which were lower than 6.00%,10.00%and 22.00%in the control group(χ2=6.186,5.674,7.686,all P<0.05).Conclusion Compared with PLIF,MIS-TLIF can achieve good results in the treatment of single-level lumbar disc herniation,which can relieve patients'pain,promote the recovery of waist function,reduce inflammatory response,and reduce the recurrence rate and incidence of complications.