开放性手术两种入路治疗老年退行性腰椎滑脱症的对比研究

Comparative Study of two approaches in the treatment of senile degenerative Lumbar spondylolisthesis

目的比较开放性手术两种入路经椎间孔椎间植骨融合术(TLIF)和经后路椎间植骨融合术(PLIF)治疗老年退行性腰椎滑脱症的疗效及安全性。方法选取2012年1月至2021年5月于我院择期行开放性手术治疗的86例老年退行性腰椎滑脱症患者,运用随机数字表法分成TLIF组(43例)和PLIF组(43例)。比较两组手术情况、住院时间及术后并发症发生情况。分别于术前和术后6月时评估两组被调查者主观疼痛情况[视觉模拟评分法(VAS)]及腰椎功能状况[腰椎日本骨科协会评估治疗分数(JOA)、Oswestry功能障碍指数(ODI)]。结果TLIF组手术情况及住院时间均显著优于PLIF组(P<0.05)。两组术后6月时疼痛VAS评分和腰椎ODI评分均较治疗前显著降低(P<0.05),腰椎JOA评分较治疗前则均显著升高(P<0.05);但两组手术前后疼痛VAS评分及腰椎JOA、ODI评分组内及组间对比差异均无统计学意义(P>0.05)。TLIF组术后并发症发生率(2.33%)与对照组(11.63%)相比显著下降,P<0.05。结论TLIF与PLIF两种开放性手术入路治疗老年退行性腰椎滑脱症均能取得满意的手术效果,但TLIF的创伤更小、并发症更少,故更有利于患者的术后快速康复。

Objective To compare the efficacy and safety of two approaches in the treatment of senile degenerative Lumbar spondylolisthesis: Transforaminal lumbar interbody fusion(TLIF)and posterior lumbar interbody fusion(PLIF).Methods From January 2012 to May 2021,86 elderly patients with degenerative Lumbar spondylolisthesis were randomly divided into TLIF Group(n=43)and PLIF Group(n=43).The operation, hospitalization time and postoperative complications were compared between the two groups.Subjective pain visual analogue scale(Vas)and Lumbar Functional Status Treatment Score(Joa)and Oswestry functional disability index(Odi)were assessed before and 6 months after surgery.Results TLIF group was better than PLIF Group(P<0.05)in operative time, intraoperative bleeding and postoperative drainage.At 6 months after operation, both VAS and Odi scores were significantly decreased(P<0.05),while Joa scores were significantly increased(P<0.05).However, there was no significant difference in VAS scores, JOA scores and Odi scores before and after operation between the two groups(P>0.05).The incidence of postoperative complications in TLIF group was 2.33%,which was significantly lower than that in control group(11.63%),P<0.05.Conclusion TLIF and PLIF are two kinds of open surgical approaches for the treatment of senile degenerative Lumbar spondylolisthesis with satisfactory surgical results, but TLIF has less trauma and complication, so it is more beneficial to the patient's rapid recovery after operation.