显微镜辅助微创通道下经椎间孔入路腰椎间融合术与开放经椎间孔椎体间融合术治疗双节段腰椎管狭窄症的短中期疗效

Short and medium term efficacy of microscope-assisted MIS-TLIF versus open-TLIF for two-segment lumbar spinal stenosis

目的 比较显微镜辅助微创通道下经椎间孔入路腰椎间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)与开放经椎间孔椎体间融合术(open transforaminal lumbar interbody fusion,open-TLIF)治疗双节段退变性腰椎管狭窄症的短中期疗效。方法 回顾我院2019年9月至2020年9月因L4-S1节段腰椎管狭窄症行手术治疗的患者,共有106例符合纳入标准,行显微镜辅助下MIS-TLIF术治疗的51例作为MIS-TLIF组,行open-TLIF术治疗的55例为开放组。比较两组的围手术期指标、功能学评分,并发症情况、临床综合疗效等。结果 显微镜辅助下MIS-TLIF组术中出血量、术后引流量、下地时间和住院时间均显著优于TLIF组(P <0.05),MIS-TLIF组的手术时间、射线暴露次数多于TLIF组(P <0.05),两组术后VAS评分及ODI评分较术前明显下降(P <0.05),VAS评分:术后1 d、1个月MISTLIF组优于TLIF组(P <0.05),术后3个月、末次随访两组比较差异无统计学意义(P> 0.05),ODI评分:术后1、3个月MIS-TLIF组优于开放组,末次随访两者ODI评分比较差异无统计学意义(P> 0.05),术后并发症发生率差异无统计学意义(P> 0.05),改良MacNab标准评价两者差异无统计学意义(P> 0.05)。结论 显微镜辅助下MIS-TLIF术治疗双节段腰椎管狭窄症的短期临床疗效明显优于open-TLIF术。

Objective To investigate the effect of microscope-assisted minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)versus open transforaminal lumbar interbody fusion(open-TLIF)for the treatment of two-segment degenerative lumbar stenosis. The short-and medium-term outcomes of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and open transforaminal lumbar interbody fusion(open-TLIF)in the treatment of two-segment degenerative lumbar spinal stenosis. Methods A total of 106 patients who underwent surgical treatment for lumbar spinal stenosis at L4-S1 segment in our hospital from September 2019 to September 2020 were selected. Fifty-one patients treated with microscope-assisted MIS-TLIF were categorized as the MIS-TLIF group,and 55 patients treated with open TLIF were categorized as the open group. The perioperative indexes,functional scores,complications and prognosis,and clinical efficacy of the two groups were compared.Results Intraoperative bleeding,postoperative drainage,time to the floor and hospital stay were significantly better in the microscope-assisted MIS-TLIF group than in the TLIF group(P < 0.05),and the MIS-TLIF group had more operative time and radiation exposure than the TLIF group(P < 0.05),and postoperative VAS scores and ODI scores were significantly lower in both groups compared with preoperative scores(P < 0.05),VAS scores. The MISTLIF group was better than the TLIF group at 1 day and 1 month postoperatively(P < 0.05),and the differences between the two groups at 3 months and the final follow-up were not statistically significant(P > 0.05),ODI scores:the MIS-TLIF group was better than the TLIF group at 1 month and 3 months postoperatively,and the differences between the two ODI scores at the final follow-up were not statistically significant(P > 0.05),and the incidence of postoperative complications was not statistically significant(P > 0.05),and the modified There was no significant difference between the two evaluated by MacNab criteria(P > 0.05). Conclusion The short-term clinical efficacy of microscope-assisted MIS-TLIF for bilateral lumbar spinal stenosis was significantly better than that of open TLIF.