TLIF与PLIF治疗多节段腰椎管狭窄症的临床效果

Comparison of the Effects of Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion on the Treatment of Multi-level Lumbar Spinal Stenosis

目的:探究经椎间孔椎体间融合术(TLIF)与腰椎经后路椎体间融合内固定术(PLIF)治疗多节段腰椎管狭窄症的临床效果。方法:选取2016年4月—2020年4月驻马店魏道德骨科医院收治的120例多节段腰椎管狭窄患者作为研究对象,根据手术方法分为TLIF组(62例)和PLIF组(58例)。比较两组患者手术时间、住院时间、切口长度、术中失血量、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎间隙高度及并发症发生情况。结果:与PLIF组比较,TLIF组切口更小,手术和住院时间更短,术中出血量更少,差异有统计学意义(t=19.439、5.128、12.217、9.524,P<0.05);两组患者VAS、ODI及椎间隙高度的时间因素和分组因素均存在交互效应,差异有统计学意义(F=4.872、4.438、3.890,P<0.05);两组患者VAS、ODI及椎间隙高度总体比较存在分组效应,差异有统计学意义(F=9.571、5.490、6.129,P<0.05);两组患者手术前后不同时间点VAS、ODI及椎间隙高度存在时间效应,差异有统计学意义(F=2773.355、1554.785、500.750,P<0.05);术后6个月,TLIF组VAS及ODI低于PLIF组,椎间隙高度高于PLIF组,差异有统计学意义(F=5.654、5.869、5.687,P<0.05);术后12个月,两组患者VAS、ODI及椎间隙高度比较,差异无统计学意义(F=1.729、1.253、1.496,P>0.05);术后随访12个月,TLIF组的并发症发生率低于PLIF组,差异有统计学意义(χ^(2)=3.928,P<0.05)。结论:PLIF与TLIF均能有效改善多节段腰椎管狭窄症的腰椎功能及缓解疼痛,但TLIF恢复快、手术创伤小、术后并发症少。

Objective:To explore the effects of TLIF and PLIF in the treatment of multi-level lumbar spinal stenosis.Methods:A total of 120 patients with multilevel lumbar spinal stenosis admitted to the hospital from April 2016 to April 2020 were selected and divided into two groups according to surgical methods.62 patients received TLIF,and the remaining 58 patients received PLIF.The operation/hospital stay,incision length,intraoperative blood loss,VAS,ODI,intervertebral space height and complications were compared between the two groups.Results:Compared with PLIF group,TLIF group had smaller incisions,shorter operation/hospital stay,and less intraoperative blood loss(t=19.439,5.128,12.217,9.524;P<0.05).There were interaction effects among time factors and grouping factors of VAS score,ODI,and intervertebral space height(F=4.872,4.438,3.890;P<0.05).The overall comparison of VAS score,ODI and intervertebral space height between the two groups showed grouping effect,with statistically significant difference(F=9.571,5.490,6.129;P<0.05).VAS score,ODI and intervertebral space height had time effects at different time points before and after surgery,with statistically significant difference(F=2773.355,1554.785,500.750;P<0.05).At 6 months after operation,the VAS score and ODI of TLIF group were lower than PLIF group,with statistically significant difference(F=5.654,5.869,5.687;P<0.05).12 months after operation,there was no significant difference in VAS score,ODI and intervertebral space height between the two groups(F=1.729,1.253,1.496;P>0.05).The incidence of complications 12 months after operation in TLIF group was lower than PLIF group(χ^(2)=3.928,P<0.05).Conclusion:Both PLIF and TLIF can effectively improve lumbar function and relieve pain in patients with multilevel lumbar spinal stenosis,but TLIF has quick recovery,less surgical trauma and fewer postoperative complications.