改良小切口肌间隙入路双侧固定单侧减压TILF手术临床疗效分析

目的　探讨改良小切口肌间隙入路双侧固定单侧减压TILF手术解剖学特点，及分析与传统术式对比治疗腰椎退变性疾病的临床疗效。 方法　回顾性分析2014年12月至2016年12月，应用改良小切口肌间隙入路双侧固定单侧减压TILF手术治疗单节段下腰椎病变患者30例（改良组）。传统术式组30例（传统组）。研究改良组TILF手术解剖学特点，比较两组病例的手术时间、术中出血量、术后引流量、术后2周VAS疼痛评分和Oswestry功能障碍评分。 结果　改良组采用双侧小切口，一侧通过Wiltse间隙入路单纯置钉固定，一侧通过改良肌间隙入路（多裂肌偏中心处间隙）置钉，减压，椎间融合固定。改良组手术时间、术中出血量、术后引流量均小于传统组（P<0.05）；两组术前VAS 评分与Oswestry功能障碍评分无显著性差异(P>0.05)；改良组术后VAS 评分小于传统组（P<0.05）；两组术后Oswestry功能障碍评分无显著性差异(P>0.05)。 结论　与传统术式相比，改良组TLIF术通过肌间隙入路更适应人体解剖学特性，手术视野佳，手术操作更容易。同时改良组还具有、手术时间短、术中出血和术后引流少、术后疼痛轻等优点。值得临床推广。

The anatomical characteristics and the analysis to clinical efficacy about modified minimally invasive surgery TILF by muscle space approach and bilateral fixation and unilateral decompression

Objective　To investigate the anatomical characteristics about modified minimally invasive surgery TILF by muscle space approach and bilateral fixation and unilateral decompression, and to analyze the clinical efficacy comparison of traditional surgical treatment of lumbar degenerative disease.　Methods　From December 2014 to December 2016，60 patients of lumbar degenerative disease, underwent one-level instrumented TLIF procedure using 2 different approaches(modified minimally invasive surgery by muscle space approach and bilateral fixation and unilateral decompression in 30 patients and traditional approach in 30 patients) by one group of surgeons．The anatomical characteristics about modified minimally invasive surgery TILF was then studied. The following data were compared between the 2 groups：surgical time，blood loss, postoperative drainage volume. The patients were followed up with VAS and Oswestry scores in Preoperative and 2 weeks after operation.　Results　The modified group was treated with bilateral minimally incision, one side was purely fixed by Wiltse gap approach, and the other side was decompressed，fused in the vertebral body and fixed by the modified intermuscular gap approach (the near center gap of multifidi). There was no obvious difference in VAS and Oswestry scores in preoperative or Oswestry scores in 2 weeks after operation (P>0.05)，but less surgical time，blood loss，postoperative drainage volume and lower VAS scores in Oswestry scores in 2 weeks after operation were notified in modified group（P<0.05）. Conclusions　Compared with the conventional approach，the modified minimally invasive surgery TILF being more adaptable to human anatomical characteristics can result in easier operation, and better surgical vision. Meanwhile, the modified group can get less surgical time，blood loss，Postoperative drainage volume and low postoperative pain．It is worthy of clinical promotion.