两种术式治疗3节段退变性腰椎管狭窄症早期疗效比较

目的比较后路椎体间融合术(PLIF)与微创通道辅助下经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗3节段退变性腰椎管狭窄症的早期疗效。方法按手术方式不同,将60例3节段退变性腰椎管狭窄症患者分为PLIF组(36例)和MIS-TLIF组(24例),比较两组手术时间、术中出血量、住院时间和随访时腰背疼痛VAS评分、下肢疼痛VAS评分、ODI评分、SF-36评分以及术后并发症。结果患者均获得随访,PLIF组随访12~20个月,MIS-TLIF组随访13~21个月。手术时间、术中出血量、住院时间两组比较差异均有统计学意义(P<0.05)。腰背疼痛VAS评分、下肢疼痛VAS评分、SF-36评分、ODI评分两组术后6、12个月与术前比较差异均有统计学意义(P<0.05)。术后6、12个月下肢疼痛VAS评分、SF-36评分、ODI评分两组比较差异均无统计学意义(P>0.05)。腰背疼痛VAS评分术后6个月两组比较差异有统计学意义(P<0.05),但术后12个月两组比较差异无统计学意义(P>0.05)。PLIF组发生脑脊液漏3例,MIS-TLIF组发生脑脊液漏1例、浅表手术部位感染2例,两组并发症例数比较差异无统计学意义(P>0.05)。影像学显示,两组患者手术节段均在术后1年内获得良好的节段融合。结论与PLIF比较,MIS-TLIF治疗3节段退变性腰椎管狭窄症出血量少、住院时间短、术后腰背疼痛症状改善速度快。

Comparison of the early efficacy of two surgery methods in the treatment of three-level degenerative lumbar spinal stenosis

Objective To compare the early efficacy of posterior lumbar interbody fusion(PLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of three-level degenerative lumbar spinal stenosis.Methods Sixty patients with three-level degenerative lumbar spinal stenosis were divided PLIF group(36 cases)and MIS-TLIF group(24 cases).The operation time,intraoperative bleeding volume,hospitalization time,VAS of low back pain,VAS of lower limb pain,ODI score,SF-36 scale of quality of life and postoperative complications were compared.Results The PLIF group was followed up for 12~20 months,and the MIS-TLIF group was followed up for 13~21 months.The operation time,intraoperative bleeding volume,hospitalization time had significant differences between the two groups(P<0.05).At 6,12 months postoperation,the VAS of low back pain,VAS of lower limb pain,ODI score,SF-36 scale of the two groups were significantly improved,compared with the preoperative(P<0.05);the VAS of lower limb pain,ODI score,SF-36 scale had no differences between the two groups(P>0.05).There was significant difference between the two groups for VAS of low back pain at 6 months after operation(P<0.05),while no significant difference existed at 12 months after operation(P>0.05).There were 3 cases of cerebrospinal fluid leakage in PLIF group,1 case of cerebrospinal fluid leakage in MIS-TLIF group and 2 cases of superficial surgical site infection.There was no significant difference in the number of complications between the two groups(P>0.05).Postoperative follow-up imaging showed that all patients had good segmental fusion within 1 year.Conclusions Compared with PLIF,MIS-TLIF has less bleeding,short hospitalization time and faster recovery in the treatment of three-level degenerative lumbar spinal stenosis.