微创与开放TLIF治疗腰椎间盘突出伴功能性侧弯

Minimally invasive TLIF versus open counterpart for single-segment lumbar disc herniation with functional scoliosis

[目的]评估内镜辅助经椎间孔腰椎融合术(minimaly invasive surgery-transforaminal lumbar interbody fusion,MISTLIF)治疗伴功能性脊柱侧弯的单节段腰椎间盘突出症的疗效。[方法]回顾性分析2014年6月—2020年12月接受手术的51例伴有功能性脊柱侧弯的单节段腰椎间盘突出症患者的临床资料,依据医患沟通结果,20例采用MIS-TLIF(微创组),31例采用开放TLIF(开放组)。比较两组临床和影像资料。[结果]两组患者均顺利完成手术,术中无神经、血管损伤等严重并发症。微创组术中出血量、切口长度、住院时间显著优于开放组(P<0.05)。随访(19.55±4.28)个月,随时间推移,两组腰腿痛VAS、ODI评分均显著降低(P<0.05),但相应时间点,两组间上述评分的差异无统计学意义(P>0.05)。影像方面,两组末次随访时侧弯Cobb角较术前均显著显著减小(P<0.05),而椎间隙高度及与L1~S1前凸角显著增加(P<0.05)。[结论]与开放TLIF相比,内镜辅助TLIF具有手术切口小、术中出血量少、术后住院时间短的优势。

[Objective]To evaluate the clinical efficacy of endoscope-assisted transforaminal lumbar interbody fusion(MIS-TLIF)for single-level lumbar disc herniation with functional scoliosis.[Methods]A retrospective study was conducted on 51 patients who underwent surgical treatment for single-level lumbar disc herniation with functional scoliosis from June 2014 to December 2020.According to doctorpatient communication,20 patients received MIS-TLIF(the MIS group),while the other 31 patients underwent open TLIF(the open group).The clinical and imaging data of the two groups were compared.[Results]All patients in both groups had operation completed successfully without serious complications.The MIS group proved significantly superior to the open group in terms of intraoperative bleeding,incision length and hospital stay(P<0.05).As time went during the follow-up lasted for(19.55±4.28)months,the VAS scores for lumbar and leg pain,as well as ODI score in both groups significantly decreased(P<0.05),whereas which were not statistically significant between the two groups at any corresponding time points(P>0.05).Radiographically,the scoliotic Cobb angle significantly decreased(P<0.05),while the height of intervertebral space and L1~S1lordotic angle significantly increased in both groups at the latest follow-up compared with those preoperatively(P<0.05).[Conclusion]This endoscope-assisted TLIF has advantages of smaller surgical incision,less intraoperative bleeding,and shorter hospital stay over the open TLIF for single-level lumbar disc herniation with functional scoliosis.