可扩张通道下行微创经椎间孔椎体间融合术治疗腰椎退行性疾病临床疗效

The clinical efficacy of MIS-TLIF in the treatment of lumbar degenerative diseases through the expandable channel

目的比较可扩张通道下行微创经椎间孔椎体间融合术(MIS-TLIF)和开放经椎间孔腰椎椎间融合术(OPEN-TLIF)治疗腰椎退行性疾病的临床疗效,为临床提供参考。方法选取2018年12月至2020年12月宣汉县人民医院收治的57例腰椎退行性疾病患者为研究对象,按照随机数字表法分为观察组(28例)和对照组(29例),观察组患者在可扩张通道下行MIS-TLIF手术,对照组患者行OPEN-TLIF手术。比较两组患者手术切口长度、手术均持续时间、术中出血量、术后引流量、卧床时间、住院时间,评估患者手术前后视觉模拟评分(VAS)、日本骨科协会下腰功能评分法(JOA)评分,随访1年。结果观察组患者的手术切口长度、手术时间、卧床时间、住院时间均短于对照组(P<0.05);观察组患者的术中出血量及术后引流量均显著少于对照组(P<0.05);观察组患者的VAS及JOA评分均明显优于对照组(P<0.05)。观察组患者术后未见切口愈合不良及切口感染,无螺钉误植入椎管神经损伤。结论与OPEN-TLIF相比,MIS-TLIF能获得相同临床效果,且创伤小、切口小、出血少、卧床时间短、康复快、腰痛率低。

Objective To compare the clinical efficacy of minimally invasive transforaminal interbody fusion(MIS-TLIF)through an expandable channel and open transforaminal lumbar interbody fusion(OPEN-TLIF)in the treatment of lumbar degenerative diseases and to provide clinical reference.Methods A total of 57 patients with lumbar degenerative diseases who were admitted to Xuanhan County People’s Hospital from December 2018 to December 2020 were selected as the research objects,and were divided into the observation group(28 cases)and the control group(29 cases)according to the random number table method.Patients in the observation group descended the expandable channel MIS-TLIF surgery and patients in the control group underwent OPEN-TLIF surgery.The length of surgical incision,duration of surgery,intraoperative blood loss,postoperative drainage,bed rest time,and hospitalization time were compared between the two groups,and the visual analogue scale(VAS)and Japanese orthopaedic association(JOA)scores were evaluated before and after surgery,and the patients were followed up 1 year.Results The length of surgical incision,operation time,bed rest time,and hospitalization time in the observation group were shorter than those in the control group(P<0.05).The intraoperative blood loss and postoperative drainage volume of the observation group were significantly less than In the control group(P<0.05);the VAS and JOA scores of the observation group were significantly better than those in the control group(P<0.05).There was no poor incision healing and incision infection in the observation group after surgery,and there was no spinal nerve injury was found by mistakenly implanting screws.Conclusion Compared with OPEN-TLIF,MIS-TLIF can achieve the same clinical effect,and has less trauma,smaller incision,less bleeding,shorter bed time,faster recovery,and lower low back pain rate.