微创经椎间孔椎间融合术治疗退变性腰椎失稳

目的对比传统开放与微创经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗单节段退变性腰椎失稳(degenerative lumbar instability,DLI)的疗效。方法回顾分析2007年3月-2009年5月收治的单节段DLI患者87例,分别采用传统开放TLIF(A组,45例)和微创TLIF(B组,42例)治疗。两组患者性别、年龄、病程、病变节段分布、腰椎合并疾病和单双侧症状的构成等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。比较两组患者的手术创伤、全身炎性反应、临床疗效及椎旁肌损伤程度。结果两组患者均顺利完成手术,无术后并发症发生。患者均获随访,A组随访时间平均2.9年,B组平均2.8年。与A组相比,B组切口较小、术中出血量和术后引流量较少,但手术时间较长,差异均有统计学意义(P<0.05)。两组术后24 h外周血C反应蛋白、白细胞计数和肌型肌酸激酶以及术后6 d C反应蛋白比较,差异有统计学意义(P<0.05)。末次随访时,两组Oswestry功能障碍指数(ODI)及疼痛视觉模拟评分(VAS)均较术前明显改善(P<0.05);两组下肢痛VAS评分差异无统计学意义(P>0.05),而ODI及腰背痛VAS评分差异有统计学意义(P<0.05)。末次随访时,A组无腰背痛8例,腰背痛轻度25例,中度9例,重度3例;B组无腰背痛18例,腰背痛轻度18例,中度6例;B组腰背痛程度较A组轻(Z=—2.574,P=0.010)。A、B组多裂肌萎缩比率分别为37%±13%、15%±7%,差异有统计学意义(t=12.674,P=0.000)。A组多裂肌萎缩Ⅰ度18侧,Ⅱ度42侧,Ⅲ度30侧;B组Ⅰ度44侧,Ⅱ度32侧,Ⅲ度8侧;两组多裂肌萎缩程度比较,差异有统计学意义(Z=—4.947,P=0.000)。结论与传统开放TLIF相比,微创TLIF具有手术创伤小、术后全身炎性反应轻、椎旁肌损伤小及术后腰背痛程度较轻的优势,但手术时间较长。

Surgical treatment of degenerative lumbar instability by minimally invasive transforaminal lumbar interbody fusion

Objective To investigate the effectiveness of surgical treatment for single-level degenerative lumbar instability(DLI) by comparing traditional open transforaminal lumbar interbody fusion(TLIF) with minimally invasive TLIF.Methods Between March 2007 and May 2009,87 patients with single-level DLI were treated by traditional open TLIF(group A,n=45) and by minimally invasive TLIF(group B,n=42),respectively.There was no significant difference in gender,age,disease duration,segment level,combined diseases of lum...