单一正中入路微创经椎间孔入路腰椎椎间融合术治疗腰椎退行性疾病

Single median approach minimally invasive transforaminal lumbar interbody fusion in treatment of lumbar degenerative diseases

目的探讨单一正中入路微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎退行性疾病的可行性、安全性及临床疗效。方法回顾性分析2020年9月—2021年6月南昌大学第一附属医院采用单一正中入路MIS-TLIF(modified MIS-TLIF组,n=53)和TLIF(TLIF组,n=53)治疗的腰椎退行性疾病患者资料,记录术中出血量、术后引流量、手术时间、术后住院时间、皮肤切口长度及并发症发生情况。术前及术后1、6、12个月使用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估疼痛程度及腰椎功能。结果所有手术顺利完成,modified MIS-TLIF组术中出血量、术后引流量、术后住院时间、皮肤切口长度及并发症发生率少于TLIF组,手术时间长于TLIF组,差异均有统计学意义(P<0.05)。2组术后1、6、12个月腰腿痛VAS评分及ODI较术前显著改善,且modified MIS-TLIF组术后1、6、12个月ODI优于TILF组,差异均有统计学意义(P<0.05)。结论相对于TLIF,单一正中入路MIS-TLIF可减少手术创伤和术中出血量,患者术后恢复快,切口并发症少;相较于传统MIS-TLIF,该技术减压空间充分,学习难度低。因此,单一正中入路MIS-TLIF是一种安全、有效的腰椎退行性疾病微创手术方式,可作为MIS-TLIF的一种替选技术方案。

Objective To investigate the feasibility,safety and clinical efficacy of single median approach minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of lumbar degenerative diseases.Methods Retrospective analysis of the data of patients with lumbar degenerative diseases treated with single median approach MIS-TLIF(modified MIS-TLIF group,n=53)and TLIF(TLIF group,n=53)at the First Affiliated Hospital of Nanchang University from September 2020 to June 2021,and intraoperative blood loss,postoperative drainage volume,operation time,postoperative hospital stay,skin incision length and the occurrence of complications were recorded.Visual analog scale(VAS)score and Oswestry disability index(ODI)were used to assess pain intensity and lumbar function at pre-operation and postoperative 1,6,and 12 months.Results All the operations were successfully completed.The intraoperative blood loss,postoperative drainage volume,postoperative hospital stay,skin incision length and complication rate in modified MIS-TLIF group were lower than those in TLIF group,and the operation time was slightly longer than that in TLIF group,all with a statistical significance(P<0.05).The VAS score of low back and leg pain and ODI of 2 groups at postoperative 1,6 and 12 months were significantly improved compared with those at pre-operation,and the ODI of modified MIS-TLIF group at postoperative 1,6,and 12 months were better than those of TILF group,all with a statistical significance(P<0.05).Conclusions Compared with TLIF,single median approach MIS-TLIF can reduce surgical trauma and intraoperative blood loss,and has faster recovery and fewer incision complications.Compared with traditional MIS-TLIF,this technology has sufficient decompression space and low learning difficulty.Therefore,single median approach MIS-TLIF is a safe and effective minimally invasive procedure for lumbar degenerative diseases,and can be used as an alternative technique for MIS-TLIF.