显微镜下MIS-TLIF联合经皮椎弓根钉内固定治疗不同节段腰椎退行性疾病短期疗效比较

Comparison of short-term efficacy of MIS-TLIF combined with percutaneous pedicle screw fixation under microscope in treatment of lumbar degenerative diseases at different levels

目的比较显微镜下微创经椎间孔腰椎椎体间融合(Minimally invasive transforaminal lumbar interbody fusion,MISTLIF)联合经皮椎弓根钉内固定治疗不同节段腰椎退行性疾病的短期疗效。方法回顾性分析自2017-04—2018-03采用显微镜下MIS-TLIF联合经皮椎弓根钉内固定治疗的48例腰椎退行性疾病,根据病变节段分为3组,其中L_(3、4)组7例,L_(4、5)组22例,L_(5)S_(1)组19例。比较3组手术时间、术中出血量、术后镇痛药物使用量,以及术后3个月、6个月、1年的疼痛VAS评分、ODI指数、JOA评分。结果48例均完成至少1年的随访,随访期间均未出现切口感染、硬膜破裂、脑脊液漏、神经功能损伤等并发症,腰腿疼痛症状均明显改善。L_(5)S_(1)组手术时间、术中出血量、术后止痛药使用量均多于L_(3、4)组和L_(4、5)组,差异有统计学意义(P<0.05);L_(5)S_(1)组术后3个月的疼痛VAS评分、ODI指数、JOA评分均差于L_(3、4)组及L_(4、5)组,差异有统计学意义(P<0.05)。结论显微镜下MIS-TILF联合经皮椎弓根钉内固定是治疗腰椎退行性疾病安全有效的手术方式。由于L_(5)S_(1)独特的解剖及生物学特性使其区别于其他节段腰椎退行性疾病。

Objective To compare the short-term efficacy of minimally invasive transforaminal lumbar interbody fusion(MISTLIF)combined with percutaneous pedicle fixation under microscope for the treatment of different lumbar degenerative diseases.Methods A retrospective analysis was conducted on 48 cases of lumbar degenerative diseases treated with MIS-TLIF under microscopic combined with percutaneous pedicle screw internal fixation from April 2017 to March 2018.They were divided into 3 groups according to the lesion segment,including 7 cases in group L_(3-4),22 cases in group L_(4-5),and 19 cases in group L_(5)S_(1).Operation time,intraoperative blood loss,postoperative analgesic drug use as well as pain VAS score,ODI index and JOA score at 3 months,6 months and 1 year after surgery were compared among the 3 groups.Results All the 48 patients were followed up for at least 1 year.During the follow-up period,there were no complications such as incision infection,dural rupture,cerebrospinal fluid leakage and nerve function injury,and the symptoms of lumbar and leg pain were significantly relieved.Operation time,intraoperative blood loss and postoperative analgesic drug use in L_(5)S_(1)group were higher than those in L_(3-4)and L_(4-5)groups,with statistical significance(P<0.05).The pain VAS score,ODI index and JOA score of L_(5)S_(1)group 3 months after operation were significantly worse than those of L_(3-4)group and L_(4-5)group,with statistical significance(P<0.05).Conclusion MISTILF combined with percutaneous pedicle screw under microscope is safe and effective for lumbar degenerative diseases.L_(5)S_(1)is distinguished from other lumbar degenerative diseases due to its unique anatomical and biological characteristics.