两种方式治疗单节段腰椎间盘突出症的疗效比较

Comparison efficacy of two kinds surgery methods for treatment of single-level lumbar disc herniation

目的比较微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)单侧椎弓根固定与经椎间孔入路腰椎椎间融合(TLIF)单侧椎弓根固定治疗单节段腰椎间盘突出症的临床疗效。方法将55例单节段腰椎间盘突出症患者根据治疗方法不同分为MIS-TLIF组(29例)和TLIF组(26例)。记录两组手术时间、切口长度、术中出血量、术后24 h引流量、住院时间及术后并发症,采用ODI评分和JOA评分评估临床疗效。结果患者均获得随访,时间6~15个月。两组手术时间、术中出血量、住院时间比较差异均无统计学意义(P>0.05)。切口长度和术后24 h引流量TLIF组长(多)于MIS-TLIF组(P<0.05)。两组均未发生切口感染、椎间隙感染、内固定松动、融合器移位、神经根损伤、硬脊膜撕裂等并发症。两组术后6个月ODI评分和JOA评分均较术前改善(P<0.05),两组比较差异均无统计学意义(P>0.05)。术后6个月JOA评分改善率两组比较差异无统计学意义(P>0.05)。结论MIS-TLIF与TLIF单侧椎弓根固定治疗单节段腰椎间盘突出症均可获得满意的临床疗效,但MIS-TLIF具有切口小、术后引流量少的优点。

Objective To compare the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)with unilateral pedicle fixation and transforaminal lumbar interbody fusion(TLIF)with unilateral pedicle fixation for treatment of single-level lumbar disc herniation(LDH).Methods The 55 patients with single-level LDH were divided into MIS-TLIF(MIS-TLIF group,29 cases)and TLIF(TLIF group,26 cases).The operation time,incision length,intraoperative blood loss,postoperative 24 h drainage volume,hospital stay and complications were recorded in two groups.Japanese Orthopaedic Association(JOA)Scores and Oswestry disability index(ODI)were used to evaluate clinical efficacy.Results All patients were followed up for 6~15 months.There were no statistical differences in operation time,intraoperative blood loss and hospital stay between the two groups(P>0.05).However,the incision length and postoperative 24 h drainage volume in the TLIF group were longer(more)than those in the MIS-TLIF group(P<0.05).There were no complications such as incision infection,intervertebral space infection,internal fixation loosening,cage displacement,nerve root injury,and dural tear in both groups.At 6 months postoperation,the ODI scores and JOA scores in the two groups were improved,compared with those of before operation(P<0.05),and there were no statistical differences between the two groups(P>0.05).JOA score improvement rate had no statistical difference between the two groups at 6 months after surgery(P>0.05).Conclusions Both MIS-TLIF and TLIF with unilateral pedicle fixation can achieve satisfactory clinical efficacy in the treatment of single-level LDH,but MIS-TLIF has the advantages of smaller incision and less postoperative drainage volume.