微创经肌间隙单双侧TLIF治疗盘源性腰痛的比较

目的比较应用微创经多裂肌间隙经椎间孔椎体间融合(transforaminal lumbar interbody fusion,TLIF)单侧固定与双侧固定治疗椎间盘源性腰痛的疗效。方法 2009年4月至2012年10月,将60例经临床检查和椎间盘造影确诊的单节段椎间盘源性腰痛患者随机分为两组,均在Quadrant系统辅助下经多裂肌间隙入路行TLIF手术。A组32例,行单侧钉棒内固定单枚Cage融合;B组28例,行双侧钉棒内固定单枚Cage融合。60例中男38例,女22例;年龄30~55岁,平均40.5岁;L3~4节段5例,L4~5节段35例,L5S1节段20例。于术后3个月、6个月、18个月进行随访,观察手术时间、术中出血量、手术损伤、并发症、植骨融合及医疗费用并进行总结分析。应用视觉模拟评分系统评估患者术前、术后疼痛情况。按照改良的MacNab法评价临床效果。结果所有手术均顺利完成,术中出血A组平均120mL,B组平均250 mL;手术时间A组平均85.5 min,B组平均120 min;治疗费用A组平均2.0万元,B组平均3.5万元;两组手术时间、出血量及治疗费用比较差异均有统计学意义(P0.05);并发症A组1例硬脊膜撕裂,B组2例,同时B组有2例非减压侧螺钉损伤神经根而行二次手术。随访8~36个月,平均25.3个月,术前VAS评分两组比较差异无统计学意义(P0.05),末次随访时同组VAS评分与术前比较差异有统计学意义(P0.01)。植骨融合率A组93.7%,B组96.4%。临床疗效评定A组优28例,良1例,可3例,优良率90.06%;B组优23例,良2例,可1例,差2例,优良率93.2%。两组间VAS评分、临床疗效及植骨融合率差异均无统计学意义(P0.05)。结论微创经多裂肌间隙入路行单侧和双侧TLIF治疗椎间盘源性腰痛均能取得较好的临床疗效,单侧TLIF手术创伤小,时间短,出血少,并发症低,安全有效,费用更低,是椎间盘源性腰痛手术治疗的一种选择。

Clinical Outcome of Unilateral and Bilateral Pedicle Screw Fixation Plus Single Cage Interbody Fusion through Spatium Intermuscalare of Muhifidus by Quadrant System for Ddiscogenic Low Back Pain

Objective To investigate the clinical outcome of unilateral and bilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus by Quadrant system for discogenic low back pain. Methods Be-tween December 2009 and August 2012,60 patients presenting with discogenic low back pain of singal segment underwent ped-icle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus by Quadrant system. 32 cases underwent a unilateral pedicle screw fixation with intervertebral body fusion（ group A ）,while 28 cases underwent bilateral pedicle screw fixation with intervertebral body fusion（group B）. There were 38 males and 22 females with the mean age of 40. 5 years（ range,30~55 years）. There were 35 cases of L4~5 fusion,20 cases of L5 S1 fusion and 5 cases of L3~4 fusion. The op-erative time,intraoperative blood loss,complications and the cost were observed. VAS score system was used to evaluate the pre-and post-operative back pain. The clinical outcomes were assessed by the MacNab method and the fusion rates was evalua-ted by the literature method. Results The average operative time was 85. 5 min in group A,120 min in group B;the average intraoperative blood loss was 120 mL in group A,250 mL in group B. The average cost in group A was 20 000 RWB and 35 000 RMB in group B. The blood loss,operation time and cost between two groups showed remarkable difference（P〈0. 05）. Preop-erative VAS score between two groups showed no significant difference（P〉0. 05）. After an follow-up of 25. 3 months（range, 8~36 months）,VAS score between two groups at final follow-up showed no significant difference（P〉0. 05）. The excellent rate and bone fusion rate between two groups showed significant difference（P〉0. 05）. Conclusion Unilateral and bilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus are both optional for disco-genic low back pain. Unilateral pedicle screw fixation