微创TLIF单侧或双侧固定治疗腰椎退行性疾病的临床疗效

The clinical outcomes of minimally invasive unilateral or bilateral TLIF for lumbar degenerative disease

中文关键词:  腰椎  退行性疾病  手术  微创

英文关键词:Lumbar vertebrae  Degenerative disease  Surgical procedures  Minimally invasive

中文摘要:

  【摘要】 目的：评价微创通道下经椎间孔腰椎椎体间融合术（TLIF）单侧或双侧固定治疗腰椎退行性疾病的临床疗效。方法：2011年1月～2012年11月应用Mast Quadrant通道对52例单节段腰椎退变性疾病的患者经椎旁多裂肌入路行TLIF单侧（31例）或双侧（21例）固定治疗。男27例，女25例，年龄30~77岁，平均52.9岁。观察二种固定方式在手术时间、术中失血量、术后住院时间及手术费用的差别。采用Oswestry功能障碍指数评分（ODI）和疼痛视觉模拟评分（VAS）评价临床疗效。通过影像学测量手术节段Cobb角（矢状位）及不同部位椎间隙的高度，观察手术前后影像学变化并评价椎体间融合情况。结果：所有患者随访3~18个月，平均12个月。两组患者在手术时间、术后住院时间及手术费用方面差异有统计学意义（P<0.01）。全部患者ODI平均值由术前的（67.67±18.59）%降至末次随访时的（25.58±20.80）%，VAS腰痛评分平均值由术前的（7.42±2.48）分降至末次随访时的（2.09±2.47）分，VAS腿痛评分平均值由术前的（8.04±1.22）分降至末次随访时的（2.46±2.07）分，手术前后差异均有显著的统计学意义（P<0.001）。单侧及双侧固定组在手术前后的ODI、VAS评分差异无统计学意义（P＞0.05）。全部患者手术后的影像学测量指标均较术前改善，且差异有统计学意义（P<0.05）。单侧及双侧固定组在手术前后影像学测量指标差异无统计学意义（P＞0.05）。除1例双侧固定患者术后出现单侧下肢症状而进行螺钉调整外，至末次随访时，所有患者均达到影像学融合标准，未发现椎弓根螺钉松动、断裂或cage移位等并发症的发生。结论：无论是单侧还是双侧固定，微创通道下经椎间孔椎体间融合术都可以有效缓解患者的临床症状。如适应证选择正确，单侧固定具有手术时间及术后住院时间短，手术费用低的优点。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes of minimally invasive unilateral or bilateral transforaminal lumbar interbody fusion(TLIF) for lumbar degenerative disease. Methods: From January 2011 to November 2012, 52 patients with single-level lumbar degeneration disease were treated through mini-TLIF for unilateral(31 cases) and bilateral(21 cases) pedicle screw fixation assisted by Mast Quadrant. The average age of patients was 52.9 years(ranged, 30-77), including 27 males and 25 females. The operation time, intraoperative blood loss, postoperative hospital stay and surgical cost were recorded. The pre- and post-operative clinical outcomes were assessed by visual analogue scale(VAS) and Oswestry disability index(ODI). The pre- and post-operative radiologic parameters were compared which included the sagittal Cobb angle and the disc height. Results: The mean follow-up time was 12 months(ranged, 3-18). There were significant differences between two groups on operation time, hospital stay and surgical cost(P<0.01). The ODI of all patients decreased from (67.67±18.59)% to (25.58±20.80)%. The VAS improved from 7.42±2.48 to 2.09±2.47 for low back pain and from 8.04±1.22 to 2.46±2.07 for leg pain. There were significant differences with respect to the improvement rate of ODI and VAS for all patients(P<0.001). There was no statistical deference between pre- and post-operative ODI and VAS scores for each group(P＞0.05). The postoperative radiologic indexes of all patients were higher than the preoperative ones(P<0.05). But no statistical difference of radiologic indexes between preoperation and final follow-up for each group was noted(P＞0.05). Except one patient with bilateral fixation adjusted pedicle screw because of leg pain after operation, at final follow-up, all the patients achieved radiographic fusion without instrument failure and other complications. Conclusions: Mini-TLIF through Mast Quadrant regardless of unilateral or bilateral fixation is reliable for degenerative lumbar disease. Unilateral fixation is of-less surgical time, less duration of postoperative hospital and less medical costs.