微创经椎间孔腰椎椎体间融合术采用两种不同内固定方式的临床对照研究

Clinical outcomes of two internal fixation in minimally invasive transforaminal lumbar interbody fusion

中文关键词:  经椎间孔腰椎体间融合术  外科手术  微创  混合内固定  对照研究

英文关键词:Transforaminal lumbar interbody fusion  Surgical procedures  Minimally invasive  Hybrid fixation  Control study

中文摘要:

  【摘要】 目的：比较微创经椎间孔腰椎椎体间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）采用单侧椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定和双侧椎弓根螺钉内固定治疗单节段腰椎退行性疾病的疗效。方法：2009年1月～2012年1月共收治82例单节段腰椎退行性疾病患者，均采用MIS-TLIF手术治疗，其中37例采用单侧切口完成双侧混合内固定（A组），45例采用双侧切口完成双侧椎弓根螺钉内固定（B组），均于术前1d、术后1d、术后3、6及12个月采用疼痛视觉模拟量表（visual analogue scale，VAS）进行疼痛评分，采用Oswestry腰椎功能障碍指数（Oswestry disability index，ODI）进行腰椎功能评分，观察并比较两组的手术时间、术中出血量、切口长度、术后下地时间、住院时间、并发症发生情况、疼痛情况和融合情况等临床结果。结果：两组患者在性别、年龄、病变节段、患病侧、随访时间和术前VAS及ODI评分均无统计学差异（P>0.05）。A组手术时间、术中出血量、切口长度、下地活动时间和住院日分别为110±24min、68±19ml、29±3mm、23±7h、2.9±1.0d；B组分别为155±35min、96±27ml、59±5mm、27±9h、3.4±1.2d，两组间比较A组均优于B组（P<0.05）。两组术后3、6及12个月随访腰痛及腿痛VAS评分和ODI评分与术前相比均有显著改善（P<0.05）。两组术后并发症发生情况、腿痛VAS、ODI评分及融合率无统计学差异（P>0.05），但术后1d腰痛VAS评分A组（4.1±0.8）优于B组（4.8±1.0）（P<0.05）。结论：采用单侧椎弓根螺钉结合对侧经椎板关节突螺钉双侧混合内固定和双侧椎弓根螺钉内固定完成MIS-TLIF手术均能达到良好的疗效，但前者更加微创。

英文摘要:

  【Abstract】 Objectives: To compare the clinical outcomes between hybrid fixation by using pedicle screws plus translaminar screw and normal pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) for single-level lumbar disc disease. Methods: From January 2009 to January 2011, 82 patients with single-level disc disease and undergoing MIS-TLIF were divided into two groups: 37 cases in unilateral hybrid fixation group(group A) and 45 cases in bilateral pedicle screw fixation group(group B). Clinical outcomes were assessed in terms of back and leg pain visual analogue scale(VAS), Oswestry disability index(ODI) at 1 day before surgery and 1 day, 3 months, 6 months and 12 months after surgery. The outcomes of operation time, intraoperative blood loss, postoperative bedtime, hospitalization time and fusion rate were compared between two groups. Results: There were no significant differences with respect to age, gender, level of fusion, diseased region and follow-up time between group A and B(P>0.05). Operation time, intraoperative blood loss, length of incision, postoperative ambulation, hospitalization time in group A was (110±24)min, (68±19)ml, (29±3)mm, (23±7)h, (2.9±1.0)d respectively, which in group B was (155±35)min, (96±27)ml, (59±5)mm, (27±9)h, (3.4±1.2)d respectively. There were significant differences between group A and group B(P<0.05). The postoperative VAS and ODI scores at 3, 6 and 12 months of two groups were better than the preoperative outcomes(P<0.05). No difference existed as for the incidence of complications, postoperative leg pain VAS and ODI scores at the same time-point and lumbar fusion between two groups(P>0.05). But the back pain VAS score of group A at postoperative 1 day was lower than that of group B(P<0.05). Conclusions: Both unilateral hybrid fixation by using pedicle screws and translaminar screw and bilateral pedicle screw fixation have comparable good clinical outcomes for MIS-TLIF.