Quadrant通道下肌间隙入路微创经椎间孔腰椎椎体间融合术对腰椎退行性疾病的临床疗效

Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion by lower Quadrant channel through the muscle gap approach in treatment of lumbar degenerative disease

目的探讨Quadrant通道下肌间隙入路微创经椎间孔腰椎椎体间融合术(MIS-TLIF)治疗腰椎退行性疾病的临床疗效及安全性。方法选取56例腰椎退行性疾病患者作为研究对象,将采用Quadrant通道下肌间隙入路MIS-TLIF治疗的32例患者纳入微创组,将采用开放性经椎间孔腰椎椎体间融合术(TLIF)治疗的24例患者纳入开放组。观察2组患者手术时间、术中出血量、切口引流量、止痛药物用量、下床活动时间、术后住院时间,并于术前和术后1周、6个月、12个月分别采用疼痛视觉模拟评分法(VAS)和Oswestry功能障碍指数(ODI)评估2组患者的疼痛情况和腰椎功能。术后12个月,比较2组患者椎间隙高度、腰椎冠状面Cobb角,并比较2组患者术后并发症发生情况。结果微创组术中出血量、切口引流量、止痛药物用量均少于开放组,术后下床活动时间、住院时间均短于开放组,差异有统计学意义(P<0.05)。术后1、3、7 d,2组患者血清磷酸肌酸激酶(CPK)水平均高于术前,但微创组血清CPK水平低于开放组,差异有统计学意义(P<0.05)。术前、术后12个月,2组患者VAS评分、ODI比较,差异无统计学意义(P>0.05);术后1周、6个月、12个月,2组患者VAS评分、ODI均低于术前,差异有统计学意义(P<0.05);术后1周、6个月,微创组VAS评分、ODI低于开放组,差异有统计学意义(P<0.05)。术后12个月,2组椎间隙高度、腰椎冠状面Cobb角比较,差异有统计学意义(P<0.05)。微创组发生并发症2例,开放组发生并发症3例,经换药保守治疗后均痊愈。结论Quadrant通道下肌间隙入路MIS-TLIF治疗腰椎退行性疾病创伤小且安全性高,患者术后恢复快,预后良好,建议在临床推广应用。

Objective To investigate the clinical efficacy and safety of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)by lower Quadrant channel through the muscle gap approach in treatment of lumbar degenerative diseases.Methods A total of 56 patients with lumbar degenerative disease were selected as study objects,and 32 patients treated with MIS-TLIF by lower Quadrant channel through the muscle gap approach were included in the minimally invasive group,and 24 patients treated with open transvertebral foraminal lumbar interbody fusion(TLIF)were included in the open group.The operation time,intraoperative blood loss,incision drainage volume,analgesic dosage,ambulation time and postoperative hospital stay of the two groups were observed,and Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the pain and lumbar function before operation,1 week,6 months and 12 months after operation.At 12 months after surgery,the height of the intervertebral space and the Cobb angle of the lumbar coronal surface of the two groups were compared,and the postoperative complications of the two groups were compared.The occurrence of adverse reactions between two groups were compared.Results Theblood loss,wound drainage volume,usage of pain medications of the minimally invasive group were less than those of the open group,while the postoperative ambulation time and hospital stay of the minimally invasive group were shorter than those of the open group(P<0.05).The levels of serum creatine phosphate kinase(CPK)at 1,3 and 7 d after operation in the two groups were significantly higher than those before operation,and the level of serum CPK in the minimally invasive group was lower than that in the open group(P<0.05).The VAS scores and ODI at 1 week,6 months,12 months after surgery of the two groups were significantly lower than those before operation(P<0.05).The VAS score and ODI at 1 week and 6 months after operation of the minimally invasive group were lower than those of the open group(P<0.05).At 12 months after operation,there were significant difference in intervertebral space height and Cobb angle of lumbar coronal plane(P<0.05).There were 2 cases with complications in minimally invasive group and 3 cases in the open group.They were all cured after conservative treatment with dressing changes.Conclusion MIS-TLIF by lower Quadrant channel through the muscle gap approach in treatment of lumbar degenerative diseases has the advantages of less trauma,higher safety,faster postoperative recovery,favorable prognosis,so it is worthy of clinical promotion.