小切口椎弓根钉棒椎间融合技术与传统手术方式治疗腰椎滑脱症的对比研究

目的：对比小切口椎弓根钉棒椎间融合技术与传统手术方式治疗腰椎滑脱症的临床疗效。方法手术治疗腰椎滑脱症100例，其中小切口椎弓根钉棒椎间融合技术组50例，传统开放组50例。分别统计两组术中出血量、手术时间、术后引流量、住院时间，术前术后疼痛视觉VSA评分、Oswestry功能障碍指数（ODI），根据Macnab标准评定临床疗效，对各影像学数据进行对比分析。结果随访12～24个月，平均18个月，小切口组手术时间、术中出血量、术后引流量、住院时间、术后随访VAS疼痛等评分指标均比传统开放手术组具有明显优势（P＜0.01）。小切口组ODI由术前的（84.4±5.3）％减小到术后末次随访的（7.7±1.3）％；传统开放组ODI由术前的（85.9±3.9）％减小到术后末次随访的（19.2±4.9）％，两组差异有统计学意义（ P＜0.01）。结论与传统开放手术相比，小切口椎弓根钉棒椎间融合技术治疗腰椎滑脱症符合微创手术的理念，减少了椎旁组织的广泛剥离，具有切口小、住院时间短、恢复快、术后腰痛少等优点，疗效确切，操作简单，适合基层医院推广。

Comparison of the mini-incision transforaminal lumbar interbody fusion with conventional open approach in treatment of lumbar spondylolisthesis

Objective To compare the clinical results between the miniincision transforaminal lumbar interbody fusion（miniincision TLIF） and conventional open approach in treatment of lumbar spondylolisthesis .Methods A total of 100 patients with lumbar spondylolisthesis underwent surgical intervention were retrospectively analyzed ,including 50 patients with miniincision TLIF and 50 patients with conventional open opproach .Operation time, intraoperative bleeding , postoperative drainage volume , and hospitalization time were recorded .Preand postoperative back pain was assessed by visual analogue scale （ VAS） ,and lumbar function was evaluated by Oswestry disability index（ODI）,the clinical results were assessed by Macnab criterion ,and radiologic parameters were compaerd .Results The mean follow-up time was 18 months （ranged,12～24）.The group of miniincision TLIF was superior to the group of conventional open in intraoperative bleeding , operation time , postoperative drainage volume and hospital stay , postoperative VAS （ P〈0.01 ） , the ODI in the patients with conventional open approach decreased from （ 85.9 ± 3.9）%before operation to （19.2 ±4.9）%at the final postoperative follow-up.The ODI in the patients with miniincision TLIF decreased from （84.4 ±5.3）%before operation to （7.7 ±1.3）% at the final postoperative follow-up. There was significant difference of the change in ODI between two groups （ P〈0.01 ） .Conclusion Compared with conventional approach , miniincision TLIF meets the concept of minimally invasive surgery in treatment of lumbar spondylolisthesis , avoids wide stripping of the vertebral adjacent tissues ,and has advantages of smaller incision ,shorter hospitalization time ,faster posteroperative recovery ,and lower back pain and so no .It has defined clinical efficacy and simple operation ,and is worth popularizing at the basiclevel hospitals .