显微镜下MIS-TLIF与腰椎后路椎间融合内固定治疗L4/5、L5/S1双节段腰椎疾病的比较

Comparative study of efficacy of microscopic MIS-TLIF and PLIF for the treatment of double-segment lumbar degenerative diseases

目的比较显微镜下微创经椎间孔腰椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)与腰椎后路椎间融合内固定术(posterior lumbar interbody fusion,PLIF)治疗L4/5、L5/S1双节段腰椎疾病的临床疗效。方法回顾性分析我科2018年1月~2020年1月收治的60例因L4-S1节段腰椎疾病行手术治疗的患者,所有患者均获得了3年以上随访。根据手术方法的不同分为MIS-TLIF组30例和PLIF组30例,记录并比较两组的围手术期指标(切口长度、手术时间、术中出血量和住院时间)以及两组术前和末次随访时的疼痛视觉模拟评分(visual analog scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI),功能学评分,并发症情况和改良MacNab标准临床疗效评价。结果MIS-TLIF组在切口长度、术中出血量和住院时间方面均明显优于PLIF组(P<0.05),而手术时间虽然在数值上大于PLIF组,但是两组间比较无统计学差异(P=0.058)。较之于治疗前,两组治疗后VAS与ODI均有改善(P<0.05),但两组间比较无统计学意义(P>0.05)。两组患者末次随访时改良MacNab标准优良率无统计学差异(P=0.193)。结论相对PLIF而言,MIS-TLIF手术治疗L4/5、L5/S1双节段腰椎疾病具有创伤小、术后并发症少和术中出血少等优势。

Objective To compare the effect of microscopic minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and posterior lumbar interbody fusion(PLIF)for the treatment of two-segment degenerative lumbar diseases.Methods From January 2018 to January 2020,the clinical data of 60 cases of two-segment lumbar degenerative diseases were retrospectively analyzed,in which 30 cases were treated with MIS-TLIF(MIS-TLIF group),and 30 cases with PLIF(PLIF group).The incision length,operation time and bleeding volume,as well as pre-operative and the last follow-up visual analog scale(VAS)and Oswestry disability index(ODI)were compared.The surgical effect was mainly evaluated by the modified MacNab criterion.Results MIS-TLIF group had shorter incision length,less intraoperative bleeding,and less hospital stay(P<0.05),but the operation time had no difference(P=0.058).VAS and ODI of the two groups were both significantly improved after operation(P<0.05),but there was no difference between two groups(P>0.05).Based on the modified MacNab criterion,there was no significant difference of clinical effect at the last follow-up(P=0.193).Conclusion Compared to PLIF,MIS-TLIF has the advantages of less trauma,fewer postoperative complications,and less intraoperative bleeding in the treatment of L4/5 and L5/S1 lumbar spine diseases.