小切口腰椎后路减压椎间植骨融合内固定术与常规切口腰椎后路椎体间融合术治疗单节段腰椎管狭窄症的效果对比

Comparison of effects of small incision transforaminal lumbar interbody fusion and conventional incision posterior lumbor interbody fusion in the treatment of single-segment lumbar spinal stenosis

目的:比较小切口腰椎后路减压椎间植骨融合内固定术(TILF)与常规切口腰椎后路椎体间融合术(PLIF)治疗单节段腰椎管狭窄症(LSS)的效果。方法:抽取2020年1月至2021年12月开封市中心医院收治的单节段LSS患者92例,按照随机数字表法分为对照组和研究组,每组46例。对照组采用常规切口PLIF治疗,研究组采用小切口TILF治疗。比较两组围术期指标、应激反应指标[皮质醇(Cor)、促肾上腺皮质激素(ACTH)]、术区及下肢视觉模拟评分法(VAS)评分、腰椎功能Oswestry功能障碍指数(ODI)评分及并发症发生率。结果:研究组手术时间长于对照组,术中出血量和术后引流量少于对照组,住院时间短于对照组(P<0.05);术后3 d,研究组Cor、ACTH水平低于对照组(P<0.05);术后1 d及术后2个月,研究组术区VAS评分低于对照组(P<0.05);术后1年,研究组ODI评分低于对照组(P<0.05);研究组并发症发生率(4.35%,2/46)低于对照组(17.39%,8/46),P<0.05。结论:与常规切口PLIF相比,小切口TILF治疗单节段LSS患者效果显著,能减少术中出血量和术后引流量,缩短住院时间,减轻机体应激反应和术后疼痛,改善患者腰椎功能,且术后并发症较少。

Objective To compare the effects of small incision transforaminal lumbar interbody fusion(TILF)and conventional incision posterior lumbar interbody fusion(PLIF)in the treatment of single-segment lumbar spinal stenosis(LSS).Methods A total of 92 patients with single-segment LSS treated in Kaifeng Central Hospital from January 2020 to December 2021 were selected and divided into control group and study group according to random number table method,with 46 cases in each group.The control group was treated by conventional incision PLIF,and the study group was treated by small incision TILF.Perioperative indexes,stress response indexes,including cortisol(Cor)and adrenocortical hormone(ACTH),the visual analogue scale(VAS)scores of the surgical area and lower limbs,lumbar functional Oswestry dysfunction index(ODI)score,and incidence of complications of the two groups were compared.Results Compared with the control group,the study group had longer operation time,less intraoperative bleeding,less postoperative drainage,and shorter hospital stay(P<0.05).The levels of Cor and ACTH in the study group were lower than those in the control group 3 days after operation(P<0.05).The 1-day and 2-month postoperative VAS score in the study group were lower than those in the control group(P<0.05).The ODI score of the study group was lower than that of the control group 1 year after surgery(P<0.05).The complication rate of the study group was 4.35%(2/46),lower than the 17.39%(8/46)of the control group(P<0.05).Conclusions Compared with conventional incision PLIF,small incision TILF has a significant effect in the treatment of single-segment LSS patients,which can reduce intraoperative blood loss and postoperative drainage volume,shorten hospital stay,reduce stress response and postoperative pain,and improve the lumbar function of patients,with liss postoperative complications.