MA-OTIF与MIS-TLIF治疗对老年性腰椎退行性病变疗效和脊柱形态的影响

目的研究小切口开放经椎间孔腰椎椎体间融合术(MA-OTIF)与微创经椎间孔入路腰椎椎体间融合术(MIS-TLIF)治疗对老年性腰椎退行性病变疗效和脊柱形态的影响。方法选取2016年3月至2018年1月本院收治的老年性腰椎退行性病变患者90例为研究对象,根据治疗方法的不同分为MA-OTIF组和MIS-TLIF组,每组45例。比较两组患者的手术时间,术中出血量,术后引流量,住院时间,术后卧床时间,术前和术后7 d、1个月、12个月的视觉模拟评分(VAS),Oswestry功能障碍评分(ODI),并发症发生率,随访12个月,观察两组患者椎间植骨融合率、脊柱侧弯情况。结果与MIS-TLIF组比较,MA-OTIF组手术时间更短,X线曝光次数更少(P均<0.05),而术中出血量、术后引流量、住院时间、术后卧床时间、并发症发生率差异无统计学意义(P均>0.05);两组术后7 d、1个月、12个月的VAS评分和ODI评分均较术前降低(P<0.05),但两组间比较差异无统计学意义(P>0.05);随访12个月,两组患者椎间植骨融合率、脊柱侧弯发生率差异均无统计学意义(P均>0.05)。结论MA-OTIF与MIS-TLIF治疗老年性腰椎退行性病变疗效相当,但MA-OTIF手术时间更短,X线曝光次数更少。

Curative effect of MA-OTIF and MIS-TLIF on elderly degenerative lumbar spine lesions and influences on spine morphology

Objective To study curative effect of mini open transforaminal lumbar interbody fusion (MA-OTIF) and minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) on elderly degenerative lumbar spine lesions and influences on spine morphology. Methods A total of 90 patients with elderly degenerative lumbar spine lesions who were admitted to our hospital from March 2016 to January 2018 were enrolled. They were divided into MA-OTIF group and MIS-TLIF group according to different treatment methods, 45 cases in each group. The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time, postoperative bed rest time, scores of visual analogue scale (VAS) before surgery, at 7 d, 1 month and 12 months after surgery, score of Oswestry disability index (ODI), and incidence of complications were compared between the two groups. The follow-up lasted for 12 months. The interbody fusion rate and scoliosis in the two groups were observed. Results Compared with MIS-TLIF group, operation time was shorter in MA-OTIF group, and number of X-ray exposure was less (P<0.05). There was no significant difference in intraoperative blood loss, postoperative drainage volume, hospitalization time, postoperative bed rest time, or incidence of complications between the two groups (P>0.05). At 7 d, 1 month and 12 months after surgery, VAS and ODI scores of the two groups were lower than those before surgery (P<0.05). However, there was no significant difference between the two groups (P>0.05). After follow-up for 12 months, there was no significant difference in rate of interbody fusion or incidence of scoliosis between the two groups (P>0.05). Conclusion The curative effect of MA-OTIF and MIS-TLIF is comparable on elderly degenerative lumbar spine lesions. However, operation time of MA-OTIF is shorter, and number of X-ray exposure is less.