经椎间孔微创椎间融合联合对侧经皮椎弓根螺钉内固定治疗腰椎退行性疾病

Minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for the treatment of lumbar degenerative diseases

目的探讨经椎间孔微创椎间融合联合对侧经皮椎弓根螺钉内固定治疗腰椎退行性疾病的临床疗效。方法选择2013-03至2016-12医院手术治疗的64例腰椎退行性疾病患者,随机分为微创组和传统组,每组32例,记录两组的手术时间、术中出血量、术后引流量、住院天数,并比较术前、术后疼痛视觉模拟VAS评分、Oswestry功能障碍指数的临床功能ODI评分。结果微创组手术时间为(132. 03±21. 73) min,术中出血量为(186. 39±51. 32) ml,术后引流量为(64. 17±31. 71) ml,术后住院天数为(7. 30±1. 06) d,与传统组相比,手术时间短、出血量少、住院时间短,差异有统计学意义(P <0. 05)。两组手术前后VAS、ODI评分比较,微创组均优于传统组,差异均有统计学意义(P <0. 05)。结论微创经椎间孔椎间融合联合对侧经皮椎弓根螺钉治疗腰椎退行性疾病,具有出血少、软组织损伤小、术后疼痛轻和住院时间短的优点,值得临床推广。

Objective To explore the clinical effect of minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for the treatment of lumbar degenerative disease,and compare this approach with a conventional one.Methods Between March 2013 and December 2016,64 patients with lumbar degenerative disease were treated,23 with minimally invasive transforaminal lumbar interbody fusion through expandable channel and percutaneous pedicle screw fixation(MI-TLIF),and the rest with the conventional approach(TLIF).The duration of surgery,intraoperative blood loss,postoperative draining loss and hospital stay were recorded.The clinical effects were evaluated according to the visual analog scale(VAS)and Oswestry Disability Index(ODI)scores.Results In the MI-TLIF group,the duration of surgery was(132.03±21.73)min,intraoperative bleeding(186.39±51.32)ml,surgical draining loss(64.17±31.71)ml,and hospital stay was(7.30±1.06)d,compared with(115.26±30.14)min,(279.13±42.65)ml,(145.14±58.12)ml,and(11.52±2.38)d in the TLIF group.The MI-TLIF group had less blood loss and shorter hospital stay,so there was significant difference between the two groups(P<0.05).The postoperative VAS and ODI scores improved significantly(P<0.05),especially at early stage.Conclusions Lumbar degenerative diseases can be effectively treated with minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation.This approach causes less blood loss,less soft tissue injury,low postoperative pain and fewer complications,which is worthy of application.