对比微创腰椎椎间固定融合术与传统开放术对单节段腰椎退行性患者腰椎功能及椎旁肌的影响

Comparison of the Effects of Minimally Transforaminal Lumbar Interbody Fusion and Traditional Open Surgery on Lumbar Function and Paraspinal Muscles in Patients with Single-Segment Lumbar Degenerative Disease

目的分析微创腰椎椎间固定融合术(MIS-TLIF)与传统开放术式对单节段腰椎退行性患者腰椎功能及椎旁肌的影响。方法回顾性选取2020年4月至2022年6月郑州市骨科医院收治的75例单节段腰椎退行性患者作为研究对象。75例患者中接受MIS-TLIF治疗的32例患者纳入微创组,接受传统切口椎间固定融合术的43例患者纳入传统组。比较两组患者的手术效果(手术时间、术中出血量、术后出血量、住院时间)、腰椎功能[功能障碍指数(ODI)、日本骨科协会下腰疼痛指数量表(M-JOA)、视觉模拟评分法(VAS)]、椎旁肌功能、血清疼痛介质指标[血一氧化氮(NO)、血清P物质(SP)、前列腺素E_(2)(PGE_(2))]以及术后并发症发生情况。结果微创组患者手术时间、术中出血量、术后出血量、住院时间均低于传统组(P<0.05)。两组患者术后3个月的ODI评分、M-JOA评分、VAS评分均相对术前降低,且微创组低于传统组(P<0.05)。两组术后3个月的多裂肌横截面积均下降,且微创组高于传统组,多裂肌脂肪沉淀等级均升高,且微创组低于传统组(P<0.05)。术后3个月两组NO、SP、PGE 2指标均下降,且微创组低于传统组(P<0.05)。微创组并发症率低于传统组(P<0.05)。结论MIS-TLIF相比较传统开放术式治疗单节段腰椎退行性患者可提高手术效果,恢复腰椎功能,保护椎旁肌功能,减轻患者疼痛程度和并发症率。

Objective To analyze the effects of minimally transforaminal lumbar interbody fusion(MIS-TLIF)and traditional open surgery on lumbar function and paravertebral muscle in patients with single-segment lumbar degenerative disease.Methods A retrospective study was conducted on 75 patients with single-segment lumbar degenerative disease admitted to Zhengzhou Orthopedic Hospital from April 2020 to June 2022.Among the 75 patients,32 patients who received MIS-TLIF treatment were included in the minimally invasive group,and 43 patients who received traditional incision intervertebral fusion surgery were included in the traditional group.The surgical outcomes(surgical time,intraoperative bleeding volume,postoperative bleeding volume,hospital stay),lumbar function[dysfunction index(ODI),Japanese orthopedic association lower back pain index(M-JOA),visual analogue scale(VAS)],paraspinal muscle function,serum pain mediator indicators[blood nitric oxide(NO),serum substance P(SP),prostaglandin E_(2)(PGE_(2))],and postoperative complications between two groups of patients were compared.Results The surgical time,intraoperative bleeding,postoperative bleeding,and hospital stay of patients in the minimally invasive group were all lower than those in the traditional group(P<0.05).The ODI score,M-JOA score,and VAS score of the two groups of patients at 3 months after surgery decreased compared to before surgery,and the minimally invasive group was lower than the traditional group(P<0.05).The cross-sectional area of the multifidus muscle in both groups decreased 3 months after surgery,and the minimally invasive group was higher than the traditional group.The lipid deposition level of the multifidus muscle increased,and the minimally invasive group was lower than the traditional group(P<0.05).Three months after surgery,the NO,SP,and PGE 2 indicators in both groups decreased,and the minimally invasive group was lower than the traditional group(P<0.05).The complication rate in the minimally invasive group was lower than that in the traditional group(P<0.05).Conclusion Compared with the traditional open surgery,MIS-TLIF can improve the surgical effect,recover lumbar function,protect paravertebral muscle function,relieve pain and reduce incidence of complications in patients with single-segment lumbar degenerative disease.