单节段与双节段TLIF治疗腰椎退行性疾病的效果

Effect of Single-segment and Double-segment TLIF in the Treatment of Lumbar Degenerative Diseases

目的:比较单节段与双节段传统经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)对腰椎退行性疾病的影响。方法:回顾性分析2018年1-12月笔者进修期间在陆军军医大学第二附属医院本组共收治的60例行腰椎TLIF手术患者的临床资料,根据手术节段的不同将其分为单节段组与双节段组,各30例。记录并比较两组术前及术后24、48、72 h C反应蛋白(CRP)、白细胞(WBC)、中性粒细胞比率(N%)、血红蛋白(HGB)、白蛋白(ALB)、前白蛋白(PA)的水平;观察两组患者的手术时间、术中出血量、术中补液量、术后血浆引流量、术后住院时间;观察术后切口感染及围术期输血及白蛋白情况。结果:两组术后24、48、72 h血清CRP、WBC、N%水平均高于术前(P<0.05);两组术后24、48、72 h的HGB、ALB、PA水平均低于术前(P<0.05);双节段组术后48 h和72 h的CRP和WBC水平均高于单节段组(P<0.05);双节段组术后48、72 h的PA水平低于单节段组(P<0.05)。双节段组手术时间及术后住院时间均长于单节段组,术中出血量、术中补液量,术后血浆引流量均多于单节段组(P<0.05)。术后1周~1个月内,双节段组切口感染发生率,围术期输血及ALB比例均高于单节段组(P<0.05)。结论:单节段及双节段TLIF手术均对患者的机体组织有一定的创伤及干扰,但单节段TLIF手术时间短、术中出血量少、术中补液量少、术后血浆引流量少及术后住院时间短,且术后发生切口感染的风险更低,双节段TLIF手术患者应激反应及机体消耗比单节段TLIF手术患者更为明显,所以临床医生应对两者术后给予不同的关注,对双节段TLIF手术者应更加注重术后抗炎及营养支持治疗,且手术切口管理需加强。

Objective:To compare the influence of single-segment and double-segment transforaminal lumbar interbody fusion (TLIF) on the lumbar degenerative diseases.Method:The clinical data of 60 patients undergoing lumbar TLIF surgery in the Second Affiliated Hospital of the Army Military Medical University during the author’s training period from January to December 2018 were retrospectively analyzed.They were divided into the single-segment group and double-segment group according to the different surgical segments of the patients at that time,30 cases in each group.The levels of C-reactive protein (CRP),white blood cell (WBC),neutrophil ratio (N%),hemoglobin (HGB),albumin (ALB) and prealbumin (PA) were recorded and compared between the two groups before and at 24,48,72 h after operation.The operation time,intraoperative blood loss,intraoperative fluid volume postoperative plasma drainage volume and postoperative hospital stay of the two groups were observed.Postoperative incision infection,perioperative blood transfusion and albumin were observed.Result:The levels of serum CRP,WBC,and N% at 24,48,72 h after operation in the two groups were higher than those before operation (P<0.05);the levels of HGB,ALB,and PA at 24,48,and 72 h after operation in the two groups were lower than before operation (P<0.05);the levels of CRP and WBC at 48 h and 72 h after operation in the double-segment group were higher than those in the single-segment group (P<0.05);the levels of PA at 48 h and 72 h after operation in the double-segment group were lower than that of the single-segment group (P<0.05).The operation time and postoperative hospital stay of the double-segment group were longer than those of the single-segment group,and the intraoperative blood loss,intraoperative fluid volume and postoperative plasma drainage volume were higher than those of the single-segment group (P<0.05).Postoperative 1 week to 1 month,the incidence of incision infection,the proportion of perioperative blood transfusion and ALB in the double-segment group were higher than those in the single-segment group (P<0.05).Conclusion:Both single-segment TLIF and double-segment TLIF have certain trauma and interference to the body tissues of patients,but single-segment TLIF has short operation time,less intraoperative blood loss,less intraoperative fluid volume,less postoperative plasma drainage volume and short postoperative hospital stay,and the risk of postoperative incision infection is lower.The stress response and body consumption of patients undergoing double-segment TLIF surgery are more obvious than those undergoing single-segment TLIF surgery,so clinicians should pay different attention to them after surgery.For patients undergoing double-segment TLIF surgery,more attention should be paid to postoperative anti-inflammatory and nutritional support therapy,and the management of surgical incision should be strengthened.