PLIF TLIF及MIS-TLIF治疗退行性腰椎管狭窄症的疗效比较

Comparison of PLIF,TLIF and MIS-TLIF in the treatment of degenerative diseases of the lumbar spine

目的比较经后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)、经腰椎间孔入路腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)及微创经椎间孔椎体间融合术(minimally invasive transforaminal lumber interbody fusion,MIS-TLIF)治疗退行性腰椎管狭窄症的临床疗效。方法采用前瞻性随机对照研究,选取广西医科大学附属民族医院2014年2月-2019年2月明确诊断退行性腰椎管狭窄症的患者72例。按照随机分配原则分为PLIF组、TLIF组和MIS-TLIF组每组24例。记录比较3组手术时间、出血量、引流量、透视次数和术后卧床时间、VAS评分、ODI评分。结果TLIF组手术时间最短(P<0.05),MIS-TLIF组的术中出血量、术后引流量及术后卧床时间明显少于其他2组(P<0.05),PLIF组术中透视次数最少(P<0.05)。3组术后VAS及ODI评分均小于术前,差异具有统计学意义(P<0.05);术后6个月,MIS-TLIF组VAS评分和ODI评分均略小于PLIF组和TLIF组,但无统计学差异(P>0.05)。3组患者植骨融合率比较差异无统计学意义(P>0.05)。结论三种融合术在治疗退行性腰椎管狭窄症上均疗效满意,但均存在局限性,仍需根据具体情况进行选择。

Objective To investigate the therapeutic effect of posterior lumbar interbody fusion(PLIF),transforaminal lumbar interbody fusion(TLIF)and minimally invasive transforaminal lumber interbody fusion(MIS-TLIF)in the treatment of single-segment lumbar spinal stenosis.Methods A prospective randomized controlled study was conducted and a total of 72 patients with single-segment lumbar spinal stenosis who admitted to our hospital from February 2014 to February 2019 were included.According to the principle of random allocation,the patients were divided into the PLIF group,TLIF group and MIS-TLIF group,with 24 patients in each group.The operation time,bleeding volume,drainage volume,compared.VAS score and ODI score were used to evaluate the efficacy among the above three groups.Results There was no statistically significant difference in basic information among the three groups(P<0.05).The operative time of TLIF was shorter,while the intraoperative blood loss,drainage volume and the time to ambulation of MIS-TLIF had more advantages,but the X-ray irradiation time was longer(P<0.05).The preoperative VAS and ODI scores among the three groups were statistically lower than postoperative scores(P<0.05),however,there was no statistical difference between groups(P>0.05).Conclusions The three groups are all satisfactory in the treatment of single-segment lumbar spinal stenosis,but they each of them have self-limitations,which means that the surgeon should choose the surgical method according to specific conditions.