微创经椎间孔椎间融合手术对单节段腰椎管狭窄症患者的治疗效果

Efficacy of Minimally Invasive Transforaminal Interbody Fusion in Patients with Single Level Lumbar Spinal Stenosis

目的 探究微创经椎间孔椎间融合手术(MIS-TLIF)治疗单节段腰椎管狭窄症(LSS)患者的效果及对腰椎骨盆参数、免疫应激及功能恢复的影响。方法 选取2019年6月至2022年6月濮阳市人民医院收治的90例单节段LSS患者为研究对象,按随机数字表法分成两组。接受常规经椎间孔椎间融合(TLIF)治疗的列为B组(45例),接受MIS-TLIF治疗的列为A组(45例)。对比两组手术指标、手术前后腰椎骨盆参数、视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、免疫应激指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、并发症发生率。结果 A组透视次数较B组多,术中失血量较B组少,术后下床活动时间较B组短,手术耗时较B组长(P<0.05);术后3、6个月两组腰椎前凸角、椎间高度、节段前凸角、骶骨倾斜角均较术前升高,骨盆倾斜角均较术前降低(P<0.05),但差异无统计学意义(P>0.05);术后3、6个月A组ODI、VAS评分较B组低(P<0.05);术后1、3 d A组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较B组高(P<0.05);A组并发症总发生率[4.44%(2/45)]较B组[20.00%(9/45)]低(P<0.05)。结论 与TLIF治疗单节段LSS患者相比,MIS-TLIF在改善腰椎骨盆解剖结构方面拥有同等效果,但在减少术中出血、缩短术后下床活动时间、提高腰椎功能、减轻疼痛感、减少并发症方面更具优势,同时对机体免疫应激影响更小,但术中需多次透视,手术时间会延长。

Objective To explore the efficacy of minimally invasive transforaminal interbody fusion(MIS-TLIF)in the treatment of patients with single level lumbar spinal stenosis(LSS)and its influence on lumbar pelvic parameters,immune stress and functional recovery.Methods Ninety patients with single-level LSS in Puyang People’s Hospital from June 2019 to June 2022 were selected and divided into two groups according to random number table method.Patients receiving conventional transforaminal interbody fusion(TLIF)were classified as group B(45 cases)and patients receiving MIS-TLIF were classified as group A(45 cases).The surgical indexes,lumbar pelvic parameters before and after surgery,visual analogue scale(VAS)scores,Oswestry disability index(ODI),immune stress index(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))and incidence of complications were compared between the two groups.Results Compared with group B,group A had more fluoroscopy times,less intraoperative blood loss and less time to get out of bed after surgery(P<0.05).At 3 and 6 months after surgery,lumbar lordosis Angle,intervertebral height,segmenial lordosis Angle and sacral inclination Angle were all increased,while pelvic inclination Angle was decreased(P<0.05),but there was no statistical difference between the two groups(P>0.05).ODI and VAS scores in group A were lower than those in group B at 3 and 6 months after surgery(P<0.05).The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in group A were higher than those in group B one day and three days after surgery(P<0.05).The total complication rate of group A[4.44%(2/45)]was lower than[20.00%(9/45)]that of group B(P<0.05).Conclusion Compared with TLIF in the treatment of single-level LSS patients,MIS-TLIF has the same effect in improving the lumbar pelvic anatomy,but it has more advantages in reducing intraoperative bleeding,shortening postoperative ambulation time,improving lumbar function,alleviating pain and reducing complications,and has less effect on the body’s immune stress.However,multiple intraoperative fluoroscopy is required.It can slightly prolong the operation time.