微创与开放经椎间孔椎间融合术治疗腰椎不稳的疗效比较

目的评价Quadrant通道下经椎间孔椎间融合术(微创TLIF)与开放经椎间孔椎间融合术(开放TLIF)两种手术方式治疗退变性腰椎不稳的临床效果。方法将53例腰椎不稳症患者分别采用开放TLIF(34例)和微创TLIF(19例)治疗,比较两组的手术时间、术中失血量、术中透视时间、术后并发症以及ODI、VAS评分等指标。结果 2例失访,51例获得随访,时间3~12个月。术中失血量、并发症发生率:微创TLIF组均少于开放TLIF组(P0.05);手术时间与术中透视时间:微创TLIF组均长于开放TLIF组(P0.05);腰背痛VAS评分:微创TLIF组术后2周、12个月时低于开放TLIF组(P0.05),术后3个月时两组比较差异无统计学意义(P0.05)。ODI评分:术后2周、3个月、12个月两组比较差异均无统计学意义(P0.05)。两组在术后12个月随访时均未发生植骨不融合。结论微创TLIF是治疗腰椎不稳症的有效方法。

Effect comparison between open TLIF and Mis-TLIF in the treatment of degenerative lumbar ;instability

Objective To evaluate the effects of Mis-TLIF and open TLIF in the treatment of lumbar spine instabili-ty. Methods Fifty-three patients suffered from lumbar spine instability were treated by two different methods:Mis-TLIF(19 cases) and open TLIF(34 cases). And clinical effects of these two methods were compared through the a-nalysis of the following parameters: operation time, mean blood loss, X-ray radiation time, complication incidence rate and Oswestry disability index ( ODI) , visual analogue scale ( VAS) , etc. Results Fifty-one patients were fol-lowed up for 3~12 months and 2 cases were lost to follow-up. The Mis-TLIF patients had a significantly longer opera-tion time, less blood loss and lower complication incidence rate (P<0. 05) and the Mis-TLIF group had more radia-tion than open TLIF group (P<0. 05). Mis-TLIF groups had better improvements in VAS at 2 weeks and 12 months (P<0. 05), and there was no difference between them at 3 months after surgery(P>0. 05). ODI scores showed no statistical difference in Mis-TLIF compared with open TLIF at 2 weeks, 3 months and 12 months (P>0. 05). And both groups showed great interbody fusion rate at 12 months. Conclusions Mis-TLIF is an effective method in the treatment of lumbar spine instability.