单侧入路双侧减压技术对腰椎退变性椎间盘疾病的治疗效果

Therapeutic effect of bilateral decompression via a unilateral approach technique on lumbar degenerative disc disease

目的比较单侧入路双侧减压技术与经椎间孔入路椎体间融合术在治疗老年腰椎退变性椎间盘疾病的临床效果及影像学结果。方法回顾性选取2017年1月至2020年4月于汕头市中心医院骨科接受手术治疗的60例老年腰椎退变性椎间盘疾病患者作为研究对象。根据手术方式的不同,分为单侧入路双侧减压(BDUA)组和经椎间孔椎体间融合(TLIF)组,每组各30例。比较两组患者手术相关并发症情况、手术时间、术中出血量、引流量、住院天数等围手术期指标,比较两组患者术前、术后的日本骨科协会评分(JOA)、视觉模拟评分法(VAS)和Oswestry功能障碍指数评分(ODI)及术后3个月融合率。结果BUDA组术中出血量、术后引流量少于TLIF组,术后3个月VAS评分低于TLIF组,差异有统计学意义(P<0.05)。两组患者术前及术后各时间点的JOA评分、ODI评分比较,差异无统计学意义(P>0.05)。两组患者术后各时间点融合率及腰椎前凸比较,差异无统计学意义(P>0.05)。两组患者术后6、12个月融合率和腰椎前凸高于本组术后3个月,差异有统计学意义(P<0.05)。两组患者术后6个月与术后12个月的融合率和腰椎前凸情况组内比较,差异无统计学意义(P>0.05)。结论单侧入路双侧减压在减少术中出血量、术后引流量,以及减轻术后早期疼痛方面更具有优势。

Objective To compare the clinical effect and imaging results of bilateral decompression via a unilateral approach technique and transforaminal lumbar interbody fusion in the treatment of senile lumbar degenerative disc disease.Methods A total of 60 patients with senile lumbar degenerative disc disease who underwent surgery in the Department of Orthopaedics,Shantou Central Hospital from January 2017 to April 2020 were retrospectively selected as research objects.According to different surgical methods,they were divided into bilateral decompression via a unilateral approach(BDUA)group and transforaminal lumbar interbody fusion(TLIF)group,with 30 cases in each group.Operation-related complications,the operation time,intraoperative blood loss,drainage volume,hospital stay and other indicators were compared between the two groups.The preoperative and postoperative Japan Orthopedic Association(JOA),visual analogue scale(VAS)and Oswestry disability index(ODI)scores were compared between the two groups.The fusion rate at 3 months after operation was compared between the two groups.Results The intraoperative blood loss,postoperative drainage volume in the BUDA group were less than those in TLIF group,and VAS score at 3 months after operation in the BUDA group was lower than that in the TLIF group,the differences were statistically significant(P<0.05).There were no significant differences in JOA score and ODI score between the two groups before and after operation(P>0.05).There were no significant differences in fusion rate and lumbar lordosis between the two groups after operation(P>0.05).The fusion rate and lumbar lordosis at 6,12 months after operation in the two groups were higher than those at 3 month after operation,the differences were statistically significant(P<0.05).Conclusion Bilateral decompression via a unilateral approach has more advantages in reducing intraoperative blood loss,postoperative drainage volume and early postoperative pain.