微创经椎间孔入路腰椎椎间融合术治疗退行性腰椎管狭窄的短期疗效及对腰椎功能的影响

Short-term efficacy of MIS-TLIF in patients with degenerative lumbar spinal stenosis and its effect on lumbar function

目的探讨微创经椎间孔入路腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗退行性腰椎管狭窄的短期疗效及对腰椎功能的影响。方法回顾性选择2020年1月至2022年6月接受诊治的退行性腰椎管狭窄患者79例,根据手术方法分为两组,微创组(n=41)接受MIS-TLIF治疗,开放组(n=38)接受开放经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗。比较两组患者手术疗效、手术相关指标和影像学指标。采用日本骨科学会(Japanese Orthopedics Association,JOA)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评估两组患者腰椎功能。采用视觉模拟量表(visual analogue scale,VAS)评估两组患者腰椎疼痛程度。结果微创组手术时间长于开放组,切口长度短于开放组,术中出血量及术后引流量少于开放组(P<0.001)。两组手术优良率、手术有效率差异无统计学意义。微创组术后3个月、术后6个月JOA评分高于开放组(P<0.01);术后3个月ODI评分,术后1 d、3 d、7 d的VAS评分均低于开放组(P<0.01)。结论MIS-TLIF治疗退行性腰椎管狭窄的短期疗效较好,可减轻患者术后疼痛,并有助于其腰椎功能恢复。

Objective To explore the short-term efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of patients with degenerative lumbar spinal stenosis and its effect on lumbar function.Methods A total of 79 patients with degenerative lumbar spinal stenosis from January 2020 to June 2022 were retrospectively selected and divided into two groups according to different surgical methods.Patients in minimally invasive group(n=41)received MIS-TLIF and patients in open group(n=38)received open transforaminal lumbar interbody fusion(TLIF).The surgical efficacy,surgery-related indicators and imaging indicators were compared between the two groups.The lumbar function was evaluated by Japanese Orthopaedics Association(JOA)score and Oswestry disability index(ODI).The degree of lumbar pain was evaluated by visual analogue scale(VAS).Results Compared with the open group,the time of surgery in the minimally invasive group was longer,the length of incision was shorter,and the intraoperative blood loss and postoperative drainage were less(P<0.001).There was no significant difference in the excellent and good rate and the effective rate of surgery between the two groups.The JOA scores at 3 months and 6 months after operation in minimally invasive group were higher than those in open group(P<0.01),and the ODI score at 3 months after operation and the VAS scores at 1 day,3 days and 7 days after operation were lower than those in open group(P<0.01).Conclusions MIS-TLIF has good short-term clinical efficacy in patients with degenerative lumbar spinal stenosis,which can relieve postoperative pain and contribute to the recovery of lumbar function.