改良微创经椎间孔腰椎间融合术治疗复发型腰椎间盘突出症

Modified minimally invasive transforaminal lumbar interbody fusion for treatment of recurrent lumbar disc herniation

目的探讨改良微创经椎间孔腰椎间融合术(MIS-TLIF)治疗复发型腰椎间盘突出症的疗效。方法将49例复发型腰椎间盘突出症患者根据治疗方式不同分为A组(13例,采用改良MIS-TLIF治疗)、B组(15例,采用MIS-TLIF治疗)和C组(21例,采用TLIF治疗)。比较3组手术情况、疼痛VAS评分及ODI,记录椎间植骨融合情况。结果术中出血量、术后引流量、血红蛋白量差值(术前-术后24 h)、术后24 h红细胞沉降率:3组比较差异均无统计学意义(P>0.05)。术后24 h VAS评分:A、B组均明显低于C组(P<0.05)。手术时间、术中透视次数、住院费用:A、C组均明显短(少)于B组(P<0.05)。患者均获得随访,时间12~35个月。ODI:3组术后1、6、12个月均较术前明显改善,差异均有统计学意义(P<0.05);术后1、6个月A与B组均优于C组(P<0.05),A、B组比较差异均无统计学意义(P>0.05);术后12个月3组之间比较差异无统计学意义(P>0.05)。3组术后下肢疼痛均完全缓解。随访中均未见椎体间植骨吸收及椎间融合器位移,椎弓根钉棒系统均未见松动及断裂。结论改良MIS-TLIF治疗复发型腰椎间盘突出症疗效满意,且可减少术中透视次数,降低患者住院费用。

Objective To investigate the clinical outcome modified minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for treatment of recurrent lumbar disc herniation.Methods Forty-nine patients with recurrent lumbar disc herniation were treated by surgery,according to different curative methods,these patients were divided into group A(13 cases were performed with modified MIS-TLIF),group B(15 cases were treated with MIS-TLIF)and group C(21 cases were adopted with TLIF).Operation situation,pain visual analogue score(VAS)and Oswestry dysfunction index(ODI)were compared among three groups,and the intervetebral bone graft fusion conditions was recorded.Results There were no significant differences in intraoperative blood loss,postoperative drainage volume,the hemoglobin difference value of the preoperative and postoperative 24 h,ESR of the postoperative 24 h among three groups(P>0.05).VAS at postoperative 24 h:group A,B were significantly lower than that of group C(P<0.05).The operation time,intraoperative fluoroscopy times and hospitalization cost:group A,C were all significantly shorter(less)than those of group B(P<0.05).All patients were followed up for 12~35 months.ODI:at the postoperative 1,6,12 months,which of three groups were obviously improved than the preoperation,with the statistical significances(P<0.05);at 1,6 months postoperation,group A,B were both better than group C(P<0.05),while there was no difference between group A and group B(P>0.05);and no differences existed among three groups at postoperative 12 months(P>0.05).The pain of lower limbs in three groups were completely relieved at the postoperation.During the follow-up,there were no complications such as absorption of intervertebral bone graft and displacement of intervertebral cage,pedicle screw-rod system loose and fracture.Conclusions The modified MIS-TLIF has satisfactory effect in the treatment of recurrent lumbar,which reduce intraoperative fluoroscopy times,and decrease the hospitalization cost.