微创经椎间孔椎体间融合术与开放经椎间孔入路椎体间融合术治疗单节段腰椎滑脱症疗效比较

Comparison of the efficacy of minimal invasive posterior transforminal lumbar interbody fusion and open transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis

目的比较微创经椎间孔入路椎体间融合术(MIS-TLIF)与开放经椎间孔椎体间融合术(open-TLIF)治疗单节段腰椎滑脱症的疗效。方法选择2017年1月至2019年7月新乡市中心医院脊柱外科收治的60例单节段腰椎滑脱症患者为研究对象。根据手术方式将患者分为MIS-TLIF组(n=32)和open-TLIF组(n=28)。比较2组患者手术时间、术中出血量、术后引流量及住院时间;分别于术前1 d、术后2周及3、6、12、24个月采用视觉模拟评分(VAS)评估患者腰、腿疼痛情况,采用日本骨科协会(JOA)评分评估患者腰椎功能改善情况,采用Oswestry功能障碍指数(ODI)评估患者腰椎功能障碍情况。术后24个月行腰椎X线评估患者的临床疗效。记录2组患者随访期间并发症发生情况。结果MIS-TLIF组患者的手术时间显著长于open-TLIF组,术中出血量、术后引流量显著少于open-TLIF组,住院时间显著短于open-TLIF组(P<0.05)。术前1 d及术后3、6、12、24个月,2组患者的腰痛和腿痛VAS评分比较差异无统计学意义(P>0.05)。术后2周,MIS-TLIF组患者腰痛VAS评分显著低于open-TLIF组(P<0.05),2组患者的腿痛VAS评分比较差异无统计学意义(P>0.05)。术后2周及术后3、6、12、24个月2组患者腰痛和腿痛VAS评分均显著低于术前(P<0.05)。术后2周及3、6、12、24个月2组患者的JOA评分显著高于术前1 d,ODI评分显著低于术前1 d(P<0.05)。术后2周及3、6、12、24个月,MIS-TLIF组患者的JOA评分显著高于open-TLIF组,ODI评分显著低于open-TLIF组(P<0.05)。术后24个月,open-TLIF组患者植骨融合率为92.9%(26/28),MIS-TLIF组植骨融合率为90.6%(29/32);2组患者植骨融合率比较差异无统计学意义(χ^(2)=0.000,P>0.05)。术后随访19.3(10~27)个月,2组患者均未出现神经损伤、感染并发症,MIS-TLIF组患者发生硬膜囊撕裂及脑脊液漏1例,经保守治疗1周后好转。结论与open-TLIF相比,MIS-TLIF治疗单节段腰椎滑脱症具有创伤小、出血量少、术后恢复快等优势,可获得良好的近期临床疗效。

Objective To compare the efficacy of minimal invasive posterior transforminal lumbar interbody fusion(MIS-TLIF)and open transforaminal lumbar interbody fusion(open-TLIF)in the treatment of single-segment lumbar spondylolisthesis.Methods Sixty patients with single-segment lumbar spondylolisthesis admitted to the Department of Spine Surgery of Xinxiang Central Hospital from January 2017 to July 2019 were selected as the research objects.The patiens were divided into MIS-TLIF group(n=32)and open-TLIF group(n=28)according to the surgical method.The operation time,intraoperative blood loss,postoperative drainage and hospitalization time stay of patients between the two groups were compared.At 1 day before surgery,2 weeks after surgery and 3,6,12,and 24 months after surgery,the patient′s waist and leg pain were evaluated by visual analogue score(VAS);the improvement of the patient′s lumbar spine function was evaluated by Japanese orthopaedic association(JOA)score;the patient′s lumbar spine dysfunction was evaluated by Oswestry dysfunction index(ODI).The clinical efficacy of the patients was evaluated by lumbar X-rays at 24 months after the operation.The occurrence of complications during the follow-up period of patients in the two groups was recorded.Results The operation time of patients in the MIS-TLIF group was significantly longer than that in the open-TLIF group,the blood loss and postoperative drainage were significantly lower than that in the open-TLIF group,the hospitalization time was shorter than that in the open-TLIF group(P<0.05).There was no significant difference in the VAS scores of waist and leg pain of patients between the two groups at 1 day before operation and 3,6,12,24 months after operation(P>0.05).At two weeks after the operation,the VAS score of waist pain of patients in the MIS-TLIF group was significantly lower than that in the open-TLIF group(P<0.05),there was no significant difference in the VAS scores of leg pain of patients between the two groups at two weeks after operation(P>0.05).The VAS scores of waist pain and leg pain in the two groups at 2 weeks and 3,6,12,24 months after operation were significantly lower than those before operation(P<0.05).The JOA score of patients in the two groups at 2 weeks and 3,6,12,and 24 months after operation was significantly higher than that at 1 day before the operation,and the ODI score was significantly lower than that at the 1 day before the operation(P<0.05).At 2 weeks and 3,6,12,and 24 months after operation,the JOA score of patients in the MIS-TLIF group was significantly higher than that in the open-TLIF group,and the ODI score was significantly lower than that in the open-TLIF group(P<0.05).At 24 months after operation,the bone graft fusion rate of patients in the open-TLIF group was 92.9%(26/28),and the bone graft fusion rate of patients in the MIS-TLIF group was 90.6%(29/32).There was no significant difference in the bone graft fusion rate between the two groups(χ^(2)=0.000,P>0.05).The postoperative follow-up was 19.3(10-27)months.There was no neurological injuries and infection complications occurred in the two groups.One case of dural sac tear and cerebrospinal fluid leakage occurred in the MIS-TLIF group,which improved after one week of conservative treatment.Conclusion Compared with open-TLIF,MIS-TLIF has advantages in treating single-segment spondylolisthesis,such as less trauma,less bleeding,and quicker recovery after surgery,and can obtain good short-term clinical effects.