微创与开放经椎间孔腰椎椎体间融合翻修术的临床疗效比较

Clinical outcomes of minimally invasive versus open transforaminal lumbar interbody fusion for lumbar revision surgery

中文关键词:  腰椎翻修  微创手术  经椎间孔椎体间融合术

英文关键词:Lumbar revision  Minimally invasive  Transforaminal lumbar interbody fusion

中文摘要:

  【摘要】目的：比较微创（minimally invasive, MIS）与开放（Open）腰椎经椎间孔椎体间融合术（transforaminal lumbar interbody fusion，TLIF）进行单节段腰椎翻修术的安全性和有效性。。方法：2009年1月~2011年12月行单节段腰椎翻修手术患者45例，其中21例患者采用MIS-TLIF手术，24例患者采用常规开放TLIF手术（Open-TLIF）。两组患者术前一般资料无显著性差异（P>0.05），比较两组患者的手术时间、术中出血量、术后下地时间和术后平均住院日，并分别于术前1d、术后5d及术后3、6个月和1年随访时采用腰痛和腿痛疼痛视觉模拟评分（visual analogue scores，VAS）、Oswestry腰椎功能障碍指数（Oswestry disability index，ODI）评价治疗效果。根据术后1年腰椎X线片和CT平扫+三维重建评价腰椎融合情况。结果：MIS-TLIF组术中出血量、术后下地活动时间和术后平均住院日均明显优于Open-TLIF组（P<0.05），而手术时间MIS-TLIF组长于Open-TLIF组（P<0.05）。两组均有2例患者硬膜撕裂。术后3、6个月和1年两组腰、腿痛VAS评分和ODI与术前比较均有显著改善（P<0.05），除术后5d腰痛VAS评分MIS-TLIF组优于Open-TLIF组（P<0.05）外，术后3、6个月和1年VAS评分和ODI两组间比较无显著性差异（P>0.05）。术后1年随访，MIS-TLIF组融合率为66.7%，Open-TLIF组为62.5%，两组比较无显著性差异（P>0.05）。结论：进行单节段腰椎翻修手术时，采用MIS-TLIF可以获得与Open-TLIF相似的安全、有效的治疗结果，并且具有创伤小、出血少、恢复快的优点。

英文摘要:

  【Abstract】 Objectives: To compare the safety and effectivity of minimally invasive(MIS) and open transforaminal lumbar interbody fusion(TLIF) for lumbar revision. Methods: From January 2009 to December 2011, 21 patients necessitating single level lumbar revision underwent MIS-TLIF, while 24 cases with the same disorders underwent traditional open TLIF. No significant difference existed for preoperative demographic data(P>0.05). The results of operation time, operative blood loss, postoperative ambulation, and bed time were compared between two groups. Futhermore, clinical outcomes were assessed by visual analogue scores(VAS) for back and leg pain, Oswestry disability index(ODI) and radiographic images at 1 day before surgery and 5 days, 3 months, 6 months and 12 months after surgery. Radiological fusion was assessed by using plain radiography and CT scans at 1 year postoperatively. Results: Operative blood loss, postoperative ambulation time and bed time for MIS-TLIF group were better than Open-TLIF group(P<0.05). 2 cases in two groups suffered from dural tear respectively, but the operation time of MIS-TLIF group was longer than that of Open-TLIF group(P<0.05). The postoperative VAS and ODI scores at 3 months, 6 months and 1 year in two groups were better than the preoperative counterparts(P<0.05). Except for the VAS score for back pain 5 days after operation in MIS-TLIF group were better than that in Open-TLIF group（P<0.05）, no difference existed at any other time point(P>0.05), and no difference existed for fusion rate between two groups at 1 year postoperatively(P>0.05), which was 66.7% for MIS-TLIF group and 62.5% for Open-TLIF group. Conclusions: For single level lumbar revision surgery, MIS-TLIF is safe, minimal invasive and effective.