交叉MIS-TLIF联合经皮椎弓根螺钉治疗双节段腰椎管狭窄伴节段失稳症

目的探讨交叉MIS-TLIF联合经皮椎弓根螺钉治疗邻近双节段腰椎管狭窄伴节段失稳症患者的临床疗效。方法选择腰椎管狭窄伴节段失稳症的患者79例,按入院先后顺序编号,按随机数分配表分为交叉MIS-TLIF联合经皮椎弓根螺钉治疗组(交叉组)48例、双侧传统MIS-TLIF治疗组(双侧组)31例,比较两组手术时间、术中出血量、术后引流量、住院时间。通过比较两组术前及术后3 d、7 d、3个月及末次随访时的腰痛视觉模拟(VAS)评分、术后1、3、6个月及末次随访时ODI指数、椎间融合率、临近节段退变率,来评估临床疗效。结果交叉组的手术时间、术中出血量、术后引流量明显少于双侧组,差异有统计学意义(均P<0.05);两组术后住院时间相当,差异无统计学意义。两组术前及术后3 d、7 d、3个月及末次随访时的腰痛VAS评分显著优于术前(P<0.01),术后3 d、7 d交叉组明显优于双侧组(P<0.05),术后3个月及末次随访时差异无统计学意义。两组术前及术后1、3、6个月及末次随访时ODI指数均明显优于术前(P<0.01),两组间比较差异无统计学意义,末次随访时椎间融合率、临近节段退变率,组间比较差异无统计学意义(P>0.05)。结论交叉MIS-TLIF联合经皮椎弓根螺钉治疗邻近双节段腰椎管狭窄伴节段失稳症患者,对腰椎后方复合体等解剖结构破坏少,术中及术后出血相对较少,两组间椎间融合率、临近节段退变率相当,同时避免了传统双侧MIS-TLIF置钉及安装纵棒的困难,简化手术操作,术后恢复快,手术效果显著。

Treatment of double-segment lumbar spinal stenosis with segmental instability with cross-MIS-TLIF combined with percutaneous pedicle screw

ObjectiveTo explore the clinical efficacy of cross-MIS-TLIF combined with percutaneous pedicle screw in the treatment of adjacent double-segmental lumbar spinal stenosis with segmental instability. Methods79 cases of lumbar spinal stenosis with segmental instability were selected. According to the sequence of admission, they were randomly divided into crossover MIS-TLIF combined with percutaneous pedicle screw treatment group (cross group, n=48) and bilateral traditional MIS-TLIF group (bilateral group, n=31). The operation time, intraoperative blood loss, postoperative drainage and hospital stay were compared between the two groups. The clinical effect was evaluated by comparing the visual analogue VAS score of low back pain before operation and 3 days, 7 days, 3 months and the last follow-up, the ODI index, the rate of interbody fusion and the rate of adjacent segment degeneration at 1, 3, 6 months after operation and the last follow-up. ResultsThe operation time, intraoperative blood loss and postoperative drainage in the cross group were significantly less than those in the bilateral group (P<0.05), but there was no significant difference in postoperative hospital stay between the two groups (P>0.05). The visual analogue scale (VAS) of low back pain before operation and at 3 days, 7 days, 3 months and the last follow-up in the two groups was significantly better than that before operation, and that in the cross group was significantly better than that in the bilateral group at 3 days and 7 days after operation (P<0.01). There was no significant difference in VAS scores between the two groups at 3 months after operation and at the last follow-up (P<0.05). The ODI index before operation and 1,3,6 months after operation and at the last follow-up in both groups were significantly better than those before operation. There was no significant difference between the two groups in the rate of interbody fusion and the rate of adjacent segment degeneration at the last follow-up (P<0.05), and there was no significant difference in the rate of interbody fusion and the rate of adjacent segment degeneration between the two groups at the last follow-up (P<0.05). ConclusionCross-MIS-TLIF combined with percutaneous pedicle screw in the treatment of adjacent double-segmental lumbar spinal stenosis with segmental instability has less damage to anatomic structures such as lumbar posterior complex, relatively less bleeding during and after operation, and the same rate of interbody fusion and adjacent segment degeneration between the two groups. at the same time, it avoids the difficulties of traditional bilateral MIS-TLIF screw placement and longitudinal rod installation, simplifies the operation, and the postoperative recovery is quick and the surgical effect is significant.