Mast Quadrant可扩张通道下MIS-TLIF治疗老年性腰椎管狭窄症的临床研究

Clinical Study of MIS-TLIF in the Treatment of Senile Lumbar Spinal Stenosis by Mast Quadrant Expandable Channel

目的:对于老年性腰椎管狭窄症(LSS)患者,在Mast Quadrant可扩张通道的基础上,给予微创经椎间孔腰椎间融合术(MIS-TLIF)治疗,观察其对患者病情的改善效果。方法:2022年1月—2023年1月,选择就诊于吉安市中心人民医院的88例老年性LSS患者纳入研究,按随机数字表法将患者以1∶1的比例分成对照组和观察组,每组44例。对照组采用经椎间孔腰椎间融合术(TLIF)治疗,观察组采用Mast Quadrant可扩张通道下MIS-TLIF治疗。比较两组围手术期指标、术后并发症发生率,记录两组术前、术后6个月、术后12个月的疼痛程度[视觉模拟评分法(VAS)]和腰椎功能[日本骨科协会评估治疗(JOA)、Oswestry功能障碍指数(ODI)]并比较,记录两组术前、术后3 d的氧化应激反应指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、促肾上腺皮质激素(ACTH)]并比较。结果:观察组的手术时间、术后卧床时间、住院时间均短于对照组,术中出血量、术后引流量均少于对照组,手术切口长度短于对照组(P<0.05)。两组VAS、ODI评分在术后6、12个月均明显低于术前,差异均有统计学意义(P<0.05),且观察组VAS、ODI评分在术后6个月均明显低于对照组,差异均有统计学意义(P<0.05);术后6、12个月,两组JOA评分均明显高于术前,差异均有统计学意义(P<0.05),且术后6个月,观察组JOA评分明显高于对照组,差异有统计学意义(P<0.05)。术后3 d,两组GSH-Px、SOD均明显低于术前,ACTH水平均明显高于术前,差异均有统计学意义(P<0.05);术后3 d,观察组GSH-Px、SOD均高于对照组,ACTH低于对照组(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:Mast Quadrant可扩张通道下MIS-TLIF治疗老年性LSS相较于传统TLIF,其手术创伤小,术中应激反应轻,可有效减轻患者术后疼痛程度并改善其腰椎功能。

Objective:To observe the improvement effect of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)on patients with senile lumbar spinal stenosis(LSS)based on Mast Quadrant expandable channel.Method:From January 2022 to January 2023,88 elderly patients with LSS in Ji’an Central People's Hospital were selected to be included in the study,and the patients were divided into control group and observation group with a ratio of 1∶1 according to random number table method,with 44 cases in each group.The control group was treated with transforaminal lumbar interbody fusion(TLIF),and the observation group was treated with MIS-TLIF under Mast Quadrant expandable channel.Perioperative indexes and postoperative complication rate were compared between the two groups;pain degree[visual analogue scale(VAS)]and lumbar function[Japanese orthopaedic association evaluation treatment(JOA)and Oswestry disability index(ODI)]were recorded and compared between the two groups before surgery,6 months after surgery,and 12 months after surgery;the oxidative stress indexes[superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and adrenocorticotropin(ACTH)]of the two groups before and 3 days after surgery were recorded and compared.Result:The operation time,postoperative bed time and hospital stay in the observation group were shorter than those in the control group,the intraoperative blood loss and postoperative drainage volume were shorter than those in the control group,and the surgical incision length was shorter than that in the control group(P<0.05).VAS and ODI scores of the two groups at 6 and 12 months after surgery were significantly lower than those before surgery,the differences were statistically significant(P<0.05),and VAS score and ODI score of the observation group were significantly lower than those of the control group at 6 months after surgery,the differences were statistically significant(P<0.05).At 6 and 12 months after surgery,JOA scores in both groups were significantly higher than those before surgery,the differences were statistically significant(P<0.05);at 6 months after surgery,JOA score in the observation group was significantly higher than that in the control group,the differences were statistically significant(P<0.05).3 dyas after surgery,GSH-Px and SOD in two groups were significantly lower than those before operation,and ACTH levels were significantly higher than those before operation,the differences were statistically significant(P<0.05);3 days after surgery,GSH-Px and SOD in observation group were higher than those in control group,and ACTH was lower than that of control group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:Compared with traditional TLIF in the treatment of senile LSS with Mast Quadrant,MIS-TLIF has less surgical trauma and less intraoperative stress reaction,which can effectively reduce postoperative pain and improve lumbar function.