微创与开放经椎间孔椎体间融合术治疗腰椎单节段退行性疾病的临床疗效比较

The minimal invasive posterior transforminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion in the treatment of single level lumbar spine degenerative diseases

中文关键词:  【关键词】 腰椎退行性疾病  微创  经椎间孔椎体间融合术  椎间融合

英文关键词:【Key words】 Lumbar degenerative diseases  Minimal invasive surgery  Transforminal lumbar interbody fusion  Interbody fusion

中文摘要:

  【摘要】目的：对比微创经椎间孔椎体间融合术（minimal invasive posterior transforminal lumbar interbody fusion，MIS-TLIF）与开放经椎间孔椎体间融合术（open transforaminal lumbar interbody fusion，open TLIF）治疗单节段腰椎退行性疾病的椎间融合率及临床疗效，评价MIS-TLIF治疗腰椎退行性疾病的安全性及有效性。方法：回顾性研究单节段腰椎退行性疾病患者48例，22例采用MIS-TLIF治疗，其中男7例，女15例，手术时年龄26～65岁，平均49.4±12.1岁；26例采用open TLIF治疗，其中男11例，女15例，手术时年龄27～70岁，平均50.7±11.8岁。比较两组的手术时间、术中出血量、术后引流量，分别采用visual analogue scores（VAS）、Oswestry disability index（ODI）、Japanese Orthopedic Association scores（JOA）评价两组治疗效果，并采用X线及CT三维重建比较两组椎间植骨融合率。结果：两组患者年龄、性别、吸烟史、BMI、手术节段均无显著差异。术前MIS-TLIF组VAS腰痛评分、VAS腿痛评分、ODI评分、JOA评分分别为4.9±2.5分、6.6±2.4分、23.3±10.2分和14.7±5.8分；open TLIF组分别为5.4±2.2分、6.0±2.8分、23.8±9.0分和3.6±4.8分，组间比较无显著差异（P＞0.05）。MIS-TLIF组手术时间、术中出血量、术后引流量分别为235.8±46.3min、198.6±81.6ml和115.7±74.5ml；open TLIF组分别为127.8±45.8min、350.0±143.6ml和494.7±243.9ml。MIS-TLIF组手术时间长于open TLIF组（P＜0.05），而术中出血量及术后引流量MIS-TLIF组均明显低于open TLIF组（P＜0.05）。平均随访时间1年（6个月~2年），术后3个月内腰痛VAS评分MIS-TLIF组改善较明显，3个月以后VAS评分两组相比无显著差异（P＞0.05）。术后3个月、6个月及末次随访两组ODI、JOA评分相比无显著差异（P＞0.05）。末次随访时，行CT三维重建判定椎间融合率，MIS-TLIF组椎间融合率81.8%（18/22），open TLIF组椎间融合率为92.3%（24/26），两组间无统计学差异（P＞0.05）。均无神经损伤、脑脊液漏、感染等并发症发生。结论：MIS-TLIF治疗单节段腰椎退行性病变，可获得与open TLIF相同的临床疗效及植骨融合率，并且出血量、引流量较少，具有较高的安全性。

英文摘要:

  【Abstract】 Objectives: To compare the fusion rate between minimal invasive posterior transforminal lumbar interbody fusion(minimal invasive posterior transforaminal lumbar interbody fusion, MIS-TLIF) and open transforaminal lumbar interbody fusion(open transforaminal lumbar interbody fusion, open TLIF), and to evaluate the safety and reliability of MIS-TLIF for single level lumbar spine degenerative diseases. Methods: 48 patients with single level lumbar degenerative diseases were followed up. Among them, 22 cases received MIS-TLIF, there were 7 males and 15 females, with a mean age of 49.4±12.1 years(range from 26 to 65 years). 26 cases received open TLIF: 11 males, 15 females, with a mean age of 50.7±11.8 years(range from 27 to 70 years). The operation time, intraoperative blood loss and postoperative drainage were compared between two groups. Clinical outcomes in terms of back pain VAS score, leg pain VAS score, ODI score and JOA score were performed before surgery and during follow-up. Futhermore, X-ray and three-dimansional computed tomography were used to evaluate the fusion status. Results: There were no significant differences between two groups in age, sex, smoking history, BMI and surgery levels(P＞0.05). The preoperative back pain VAS score, leg pain VAS score, ODI score and JOA score in MIS-TLIF group were 4.9±2.5, 6.6±2.4, 23.3±10.2, 14.7±5.8 respectively; and 5.4±2.2, 6.0±2.8, 23.8±9.0, 13.6±4.8 respectively in open TLIF group. Operation time, intraoperative blood loss, postoperative drainage in MIS-TLIF group were 235.8±46.3min, 198.6±81.6ml, 115.7±74.5ml respectively; and 127.8±45.8min, 350.0±143.6ml, 494.7±243.9ml respectively in open TLIF group. Although the operation time of MIS-TLIF group was longer than that of open TLIF group(P＜0.05), the blood loss and the postoperative drainage of MIS-TLIF group were less than those of open TLIF group(P＜0.05). After a mean follow-up of 12 months, the VAS score of back pain in MIS-TLIF group was lower than that of open TLIF group within 3 months after operation(P＜0.05), and there was no difference between two groups regarding to VAS score after 3 months of postoperation. X-ray and three-dimansional computed tomography were performed at the final follow-up. Lumbar fusion rate assessed by three-dimansional computed tomography in MIS-TLIF group was 81.8%(18/22), and 92.3%(24/26) in open TLIF group. The lumbar spine fusion rate in MIS-TLIF group was lower than that in open TLIF group, but no significant difference(P＞0.05) was noted. There were no complications in two groups. Conclusions: For single level lumbar spine degenerative diseases, MIS-TLIF can achieve similar result and similar fusion rate with the open TLIF. MIS-TLIF is of high reliability because of lower bleeding and drainage.