XLIF与MIS-TLIF手术治疗腰椎退行性疾病的疗效分析

XLIF and MIS-TLIF in the treatment of lumbar degenerative diseases

目的 分析比较小切口极外侧融合术(extreme lateral interbody fusions, XLIF)与微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF)治疗腰椎退行性疾病的疗效。方法 回顾性分析2017年2月~2019年2月于本院收治的腰椎退行性疾病80例患者临床资料,依据手术方式分为两组:MIS-TLIF组43例,XLIF组37例。所有患者术后随访24~31个月、平均26.3个月。统计两组患者的手术指标、手术疗效,以及手术前后影像学指标,对上述指标进行分组比较,综合分析各自的优劣。结果 与XLIF组患者相比,MIS-TLIF组的手术时间显著延长,而且术中失血量显著增加(P<0.05);但MIS-TLIF组患者的并发症发生率显著低于XLIF组(7.0%vs. 18.9%),差异有统计学意义(P<0.05)。与术前相比,两组患者术后3个月和末次随访时的VAS评分、ODI指数均显著降低,JOA评分则显著升高(P<0.05),上述指标的组间差异无统计学意义(P>0.05)。截止末次随访,两组患者均达到椎间植骨融合标准,融合率均为100%。XLIF组患者末次随访时的椎间隙高度和融合节段前凸角均显著大于MIS-TLIF组(P<0.05)。结论 MIS-TLIF与XLIF手术均是治疗腰椎退行性疾病的有效微创术式,XLIF的手术时间更短、术中出血更少,且在维持腰椎间隙高度和生理曲度方面表现更好,但并发症发生率偏高。

Objective To analyze and compare the advantages and disadvantages of small incision extreme lateral interbody fusions(XLIF) and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative diseases, so as to provide reference for clinical decision-making. Methods The clinical data of 80 patients with lumbar degenerative diseases treated in our hospital from February 2017 to February 2019 were analyzed retrospectively. They were divided into two groups according to different surgical methods: 43 cases in MIS-TLIF group and 37 cases in XLIF group. All patients were followed up for 24-31 months, with an average of 26.3 months. The operation indicators, operation efficacy and imaging indicators before and after operation of the two groups were collected, and the above indicators were grouped and compared to comprehensively analyze their advantages and disadvantages. Results Compared with XLIF group, the operation time of MIS-TLIF group was significantly prolonged, and the intraoperative blood loss was significantly increased(P<0.05). However, the incidence rate of complications in MIS-TLIF group was significantly lower than that in XLIF group(7.0% vs. 18.9%)(P<0.05). Compared with before operation, the VAS score and ODI index of the two groups decreased significantly at 3 months after operation and at the last follow-up, while the JOA score increased significantly(P<0.05). There were no significant differences in the above indicators between the two groups before and after operation(P>0.05). By the end of the last follow-up, patients in both two groups had reached the standard of interbody fusion, and the fusion rate was 100%. The intervertebral space height and anterior convex angle of fusion segment in XLIF group were significantly higher than those in MIS-TLIF group at the last follow-up(P<0.05). Conclusion s MIS-TLIF and XLIF are effective minimally invasive methods for the treatment of lumbar degenerative diseases. XLIF has shorter operation time, less intraoperative bleeding, and better performance in maintaining the height and physiological curvature of lumbar space. Compared with MIS-TLIF, XLIF has a higher incidence of complications, but it does not cause permanent damage.