微创经椎间孔入路腰椎椎体间融合术治疗腰椎退行性疾病的疗效评价

目的探讨Quadrant可扩张通道系统辅助下微创经椎间孔入路腰椎椎体间融合术(MIS-TLIF)治疗腰椎退行性疾病的临床疗效。方法将十堰市人民医院骨科2014年5月至2017年5月收治的采用经Quadrant可扩张通道下MIS-TLIF治疗单节段腰椎退行性疾病的50例患者设为MIS-TLIF组,并随机抽取同期采用传统开放经椎间孔入路腰椎椎体间融合术(O-TLIF)治疗单节段腰椎退行性疾病的50例患者设为O-TLIF组。记录2组患者手术切口长度、手术时间、术中出血量、术后引流量及住院时间,在术前、术后1个月及末次随访时对所有患者进行疼痛视觉模拟评分(VAS)、腰痛疗效JOA评分、生活质量量表(SF-36)评估、改良Macnab标准优良率评价及影像学评估。结果所有患者均随访11~26个月,平均(14.8±6.5)个月。MIS-TLIF组手术时间与O-TLIF组比较,差异无统计学意义(P>0.05);与O-TLIF组比较,MIS-TLIF组手术切口长度较短,术中出血量较少,术后引流量较少,平均住院时间较短,差异有统计学意义(P<0.05)。术后2组患者VAS、JOA评分均较术前明显改善,差异有统计学意义(P<0.05);与O-TLIF组比较,术后1个月MIS-TLIF组VAS、JOA评分改善更明显,差异有统计学意义(P<0.05);末次随访时,2组患者VAS、JOA评分比较差异无统计学意义(P>0.05)。与术前比较,术后2组患者SF-36量表评定各维度总得分均改善,MIS-TLIF组改善程度高于O-TLIF组,差异有统计学意义(P<0.05)。根据改良Macnab标准,末次随访时MIS-TLIF组优良率为96%,O-TLIF组优良率为94%,2组比较差异无统计学意义(P>0.05)。按Bridwell椎间融合标准,2组融合率均为100%,但MIS-TLIF组平均椎间融合时间较O-TLIF组短,差异有统计学意义(P<0.05)。结论MIS-TLIF与O-TLIF技术均可以有效治疗成人腰椎退行性疾病,但MIS-TLIF技术具有手术创伤小、出血少、术后恢复快、椎间融合时间短及能有效维持术后脊柱稳定性等优点。

Clinical efficacy of minimally invasive transforminal lumbar interbody fusion in treatment of lumbar degenerative disease

Objective To investigate the clinical efficacy of minimally invasive transforminal lumbar interbody fusion(MIS-TLIF)assisted by Quadrant in the treatment of lumbar degenerative disease.Methods From May 2014 to May 2017,a total of 50 patients with lumbar degenerative disease who were treated by MIS-TLIF in orthopaedics department of people′s hospital of Shiyan were selected as MIS-TLIF group,and a total of 50 patients with lumbar degenerative disease who were treated by open transforminal lumbar interbody fusion(O-TLIF)during the same period were selected as O-TLIF group.The follow-up evaluation included length of incision,operation time,blood loss,volume of drainage after operation and hospital stay of two groups were recorded,and VAS score,JOA score,SF-36 scores,the excellent and good rate based on MacNab criteria and the image data of patients before surgery,1 month after surgery and the last follow-up were enaluated and analyzed.Results All patients were followed up for 11 to 26 months,with an average of(14.8±6.5)months.There was no significant difference in operation time between MIS-TLIF group and O-TLIF group(P>0.05).In the MIS-TLIF group,the length of incision was shorter than that in O-TLIF group,meanwhile the blood loss,the volume of drainage after operation and hospital stay were less than those in O-TLIF group,and the differences were significant(P<0.05).The VAS score and JOA score were apparently improved after surgery compared with those before surgery in each group(P<0.05).At 1 month after surgery,the VAS score and JOA score were significantly improved in MIS-TLIF group compared with those in the O-TLIF group,the differences were significant(P<0.05).There was no difference in VAS score and JOA score at the last follow-up between two groups(P>0.05).There was a substantial improvement in each total scores of SF-36 as compared with that before surgery,moreover,MIS-TLIF group was better than that of O-TLIF group,the differences were significant(P<0.05).At the last follow-up,the excellent and good rate based on MacNab criteria of MIS-TLIF group was 96%,and that of O-TLIF group was 94%,there was no difference between two groups(P>0.05).The rate of fusion which evaluated by Bridwell standard in two groups were both 100%,while the fusion time of MIS-TLIF group was shorter than that of O-TLIF group,the difference was significant(P<0.05).Conclusion Both MIS-TLIF and O-TLIF are effective for the treatment of lumbar degenerative disease in adult patients,while the MIS-TLIF has the advantages of less surgical trauma,less bleeding,fast recovery,shoter fusion time and better postoperative spinal stability.