经椎间孔腰椎椎间融合术治疗腰椎间盘突出症32例

32 Cases of Clinical Efficacy of MIS-TLIF in the Treatment of Lumbar Disc Herniation

目的:探讨微创经椎间孔腰椎椎间融合术(MIS-TLIF)治疗腰椎间盘突出症的临床疗效。方法:回顾性分析2017年1月至2019年6月采用MIS-TLIF治疗的32例腰椎间盘突出症患者,收集患者手术时间、术中出血量、术后引流量、椎间融合率及术后相关并发症,记录手术前后的椎间隙高度(DH)、腰椎前凸角(LL)、融合节段角(FSA)、疼痛视觉模拟量表评分(VAS)及Oswestry功能障碍指数(ODI)。结果:32例患者随访12~15个月,平均12.9个月。手术时间为(191.34±42.34)min(123~269 min),术中出血量为(154.38±42.14) mL(97~262 mL),术后引流量为(61.03±19.21) mL(32~94 mL)。术后切口浅表感染1例,经保守治疗痊愈;置钉位置不佳1例,末次随访时未出现不适。术后不同时点的VAS评分、ODI均较术前显著改善,差异均有统计学意义(P<0.05);随术后时间推移,VAS评分及ODI持续下降,差异有统计学意义(P<0.05)。影像学方面,术后1周及术后12个月的DH、LL、FSA均较术前显著改善,差异有统计学意义(P<0.05);术后1周上述指标和术后12个月比较,差异均无统计学意义(P>0.05)。随访期间椎间融合率为90.62%,未发现融合器移位、下沉及内固定装置松动断裂等情况。结论:MIS-TLIF治疗腰椎间盘突出症能解除神经压迫,恢复椎间隙高度和脊柱稳定性,改善患者生活质量,具有创伤小、出血少、术后恢复快等优势,疗效确切。

Objective:To explore the clinical effect of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar disc herniation.Methods:32 patients with lumbar disc herniation treated by MIS-TLIF from January 2017 to June 2019 were analyzed retrospectively.The operation time, intraoperative blood loss, postoperative drainage, interbody fusion rate and postoperative complications were collected.The height of intervertebral space(DH),lumbar kyphosis angle(LL),fusion segment angle(FSA),pain visual analogue scale(VAS) and Oswestry dysfunction index(ODI) were recorded before and after operation.Results:32 patients were followed up for 12 to 15 months, with an average of 12.9 months.The operation time was(191.34±42.34) min(123 to 269 min),intraoperative blood loss was(154.38±42.14) ml(97 to 262 mL),postoperative drainage was(61.03±19.21) mL(32 to 94 mL).Postoperative superficial incision infection occurred in 1 case, which was cured by conservative treatment, and poor nail placement was found in 1 case, and there was no discomfort at the last follow-up.The VAS score and ODI at different time points after operation were significantly improved as compared with those before operation(P<0.05),and the VAS score and ODI decreased continuously with the passage of time after operation(P<0.05).In terms of imaging, DH, LL and FSA at 1 week and the last follow-up were significantly improved as compared with those before operation(P<0.05),but there was no significant difference between the above indexes at 1 week after operation and 1 year after operation(P>0.05).During the follow-up period, the interbody fusion rate was 90.62%,and no cage displacement, subsidence, loosening and fracture of the internal fixation device were found.Conclusion:MIS-TLIF treatment of lumbar disc herniation can relieve nerve compression, effectively restore the height of intervertebral space and spinal stability, and improve the quality of life of patients.It has the advantages of less trauma, less bleeding and rapid recovery after operation.