经椎间孔腰椎体间融合术治疗腰椎滑脱伴腰椎管狭窄症的临床效果分析

Clinical Effect of Transforaminal Lumbar Interbody Fusion in Treatment of Lumbar Spondylolisthesis Complicated with Lumbar Spinal Stenosis

目的:评价经椎间孔腰椎体间融合术治疗腰椎滑脱伴腰椎管狭窄症的临床效果。方法:选择笔者所在医院2016年2月-2018年2月96例腰椎滑脱伴腰椎管狭窄症患者,根据手术方式分为两组,开放组51例采用行后路腰椎椎体间融合术治疗,微创组45例采用经椎间孔腰椎体间融合术治疗,比较两组手术时间、术中出血量、术后引流量、卧床时间;比较术后3 d、6个月、24个月疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。结果:微创组手术时间长于开放组,卧床时间短于开放组,术中出血量、引流量少于开放组(P<0.05)。微创组术后3 d、术后6个月、24个月VAS、ODI评分均明显低于开放组(P<0.05)。开放组并发症发生率高于微创组(P<0.05)。术后6个月,两组滑脱复位率比较差异无统计学意义(P>0.05)。术后6、24个月两组腰椎水平位移、角位移比较差异无统计学意义(P>0.05)。结论:经椎间孔腰椎体间融合术治疗腰椎滑脱伴腰椎管狭窄症可在确保手术疗效的前提下,减少手术创伤,提高安全性,是一种有效、安全的微创术式。

Objective:To evaluate the clinical effect of transforaminal lumbar interbody fusion treatment of lumbar spondylolisthesis complicated with lumbar spinal stenosis.Method:A total of 96 cases of patients with lumbar spondylolisthesis complicated with lumbar spinal stenosis and who treated in our hospital from February 2016 to February 2018 were selected,and the patients were divided into two groups according to the operation method.The open group of 51 cases were treated with posterior lumbar interbody fusion,and the minimally invasive group of 45 cases were treated with transforaminal lumbar interbody fusion.Then,the operation time,intraoperative blood loss,postoperative drainage volume and bed rest time were compared between the two groups,and the visual analogue scale (VAS) and Oswestry disability index (ODI) after operation for 3 d,6 months and 24 months were compared.Result:The operation time in the minimally invasive group was longer than that in the open group,the bed rest time was shorter than that in the open group,and the intraoperative blood loss and drainage volume in the minimally invasive group were less than those in the open group (P<0.05).The VAS and ODI scores after operation for 3 d,6 months and 24 months in the minimally invasive group were significantly lower than those in the open group (P<0.05).The incidence of complications in the open group was higher than that in the minimally invasive group (P<0.05).After operation for 6 months,there was no significant difference in the reduction rate of slippage between the two groups (P>0.05).There was no significant difference in lumbar horizontal displacement and angular displacement between the two groups after operation for 6 and 24 months (P>0.05).Conclusion:The transforaminal transforaminal lumbar interbody fusion in treatment of lumbar spondylolisthesis complicated with lumbar spinal stenosis can ensure the clinical effect,reduce the surgical trauma and improve the safety,thus it is an effective and safe minimally invasive operation.