两种手术方式治疗退变性腰椎管狭窄的比较

Comparison of two surgical techniques for degenerative lumbar spinal stenosis

[目的]研究单侧微创经椎间孔椎体间融合术(minimally invasive surgery-transforaminal lumbar interbody fusion,MISTLIF)与传统经椎间孔椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗退变性腰椎管狭窄的疗效。[方法]回顾性分析2017年1月~2018年6年手术治疗的退变性腰椎管狭窄患者104例,其中50例采用单侧MIS-TLIF治疗,54例采用传统TLIF治疗。比较两组围手术期、随访及影像学指标。[结果]单侧MIS-TLIF组手术时间、术中出血量、术后引流量均低于常规TLIF组,差异有统计学意义(P<0.05)。随时间推移,两组患者VAS和ODI评分均显著下降(P<0.05);术后1个月和末次随访单侧MIS-TLIF组VAS评分与ODI评分均显著低于常规TLIF组(P<0.05)。影像方面,术后1个月和末次随访时两组患者的椎间盘背侧高度、椎间盘腹侧高度、椎间孔高度、椎间孔面积及椎间前凸角较术前显著增加(P<0.05);末次随访时两组患者的上述影像测量指标均较术后1个月无显著改变(P>0.05)。[结论]单侧MIS-TLIF与传统TLIF治疗退变性腰椎管狭窄均可取得较好的临床疗效,相比之下,单侧MIS-TLIF在手术时间、出血量、手术创伤、术后恢复速度等方面均具有明显的优势。

[Objective]To compare the clinical outcomes of unilateral minimally invasive surgery-transforaminal lumbar in⁃terbody fusion(MIS-TLIF)versus the conventional transforaminal lumbar interbody fusion(TLIF)for degenerative lumbar spinal stenosis.[Methods]A retrospective study was conducted on 104 patients who underwent surgical treatments for de⁃generative lumbar spinal stenosis from January 2017 to June 2018.Of them,50 patients received unilateral MIS-TLIF,while the remaining 54 patients had conventional TLIF performed based on the consequence of patient-doctor communication.The patients in the two groups were compared regarding the perioperative,follow-up and radiographic data.[Results]The MIS-TLIF group consumed significantly less operation time,associated with significantly less intraoperative blood loss,and postoperative drainage volume than the TLIF group(P<0.05).As time went the VAS and ODI scores significantly decreased in both groups(P<0.05).The MIS-TLIF group proved significantly superior to the TLIF group in VAS and ODI scores at 1 month postoperatively and the latest follow up(P<0.05).With regard to radiographic assessment,the ventral intervertebral height,dorsal intervertebral height,foraminal height,foraminal area and lordotic angle significantly increased at 1 month postoperatively and the latest follow up compared with those before operation(P<0.05),which remained unchanged be⁃tween the time points at 1 month and the latest follow up(P>0.05).[Conclusion]Both the unilateral MIS-TLIF and conven⁃tional TLIF do achieve satisfactory clinical outcomes for degenerative lumbar spinal stenosis.By contrast,the unilateral MISTLIF takes the advantages in operation time,bleeding volume,surgical trauma and postoperative recovery over the conven⁃tional TLIF.