传统和微创经椎间孔椎体间融合术临床效果对比

Conventional versus minimally invasive transforaminal lumbar interbody fusion for disc herniation accompanied with single segment lumbar instability

[目的]探讨和对比微创下经椎间孔椎体间融合术(MIS-TLIF)与传统TLIF治疗椎间盘突出症伴腰椎不稳的临床疗效。[方法]回顾性分析2013年5月～2016年1月行MIS-TLIF和TLIF手术的单节段椎间盘突出症伴腰椎不稳的65例患者,其中MIS-TLIF 20例、TLIF45例,比较两组患者手术时间、出血量、术中辐射量、住院时间和平均费用。对比术后并发症,临床效果及术后融合率。[结果] MIS-TLIF组手术时间及射线暴露时间明显长于TLIF组(P<0.05),出血量明显少于TLIF组(P<0.05);住院时间明显短于TLIF组(P<0.05);耗材费用明显高于TLIF组(P<0.05),但非耗材费用明显低于TLIF组(P<0.05)。MIS-TLIF组2例椎弓根螺钉不佳,但无神经症状未做特殊处理。TLIF组3例切口感染,1例脑脊液漏并发颅内感染。术后两组疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)较术前明显改善,但相同时间点两组间差异无统计学意义(P>0.05)。末次随访时,根据Bridwell腰椎融合评价标准,MIS-TLIF组和TLIF组融合率分别为85.00%和91.11%,差异无统计学意义。(P>0.05)[结论] MIS-TLIF治疗单节段椎间盘突出症伴腰椎不稳可以达到传统TLIF治疗相同的临床效果,具有创伤小,出血少,术后并发症少,术后花费少等优点,但术中时间和辐射量大,内置物费用高。

[Objective] To compare the clinical outcomes of conventional versus minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) for treatment of lumbar disc herniation accompanied with single segment lumbar instability.[Methods] A retrospective study was conducted on 68 patients who underwent surgical treatment for lumbar disc herniation accompanied with single segmental lumbar instability. Of them, 20 patients received MIS-TLIF, while the other 48 patients had conventional TLIF. The operation time, blood loss, frequency of X-ray exposure, hospital stay, hospital costs, complications, as well as Oswestry disability index(ODI) and visual analogue scale(VAS) for pain were compared between the two groups. In addition, lumbar fusion rates were assessed on radiographic images according to Bridwell grading. [Results] The MIS-TLIF group had significantly longer operation time, longer X-ray exposure, less blood loss, less complications and shorter hospitalization than the TLIF group(P<0.05). Although the MIS-TLIF group spend significantly more consumable cost than the TLIF group(P<0.05), the former had significantly less non-consumable cost than the latter(P<0.05). Both ODI and VAS scores in the two groups significantly improved after operation compared with those before operation(P<0.05). However, no statistically significant difference was proved at any corresponding time point between the two groups in ODI and VAS scores(P>0.05). At the latest follow up, the lumbar fusion rate proved 85.0% in the MIS-TLIF group, whereas 91,1% in the TLIF group based on Bridwell criteria, which was not statistically significant(P>0.05). [Conclusion] The MIS-TLIF does achieve satisfactory clinical outcomes similar to the TLIF, however, the MIS-TLIF takes advantage of minimal iatrogenic trauma, reduced blood loss, less com-plication and lower postoperative cost over the TLIF despite of longer X-ray exposure and more consumable cost.