显微镜辅助下MIS-TLIF治疗腰椎单节段退行性疾病的临床疗效观察

目的　探讨显微镜辅助下微创经椎间孔椎体间融合术（minimal invasive posterior transforminal lumbar interbody fusion，MIS-TLIF）治疗腰椎单节段退行性疾病的安全性及有效性。 方法　回顾分析显微镜辅助下MIS-TLIF术42例（微创组）及同期行后路腰椎椎间融合术50例（传统组）治疗腰椎单节段退行性疾病患者临床资料，比较两组围手术期指标及临床疗效。 结果　手术切口长度、术中出血量、术后引流量、术后住院时间、术后1 d肌酸激酶水平、术后3月ODI评分及术后1 d、术后3月VAS评分比较，微创组均低于传统组（P<0.05）；手术时间、术中X线照射次数，微创组多于传统组（P<0.05）。微创组患者出现1例术后背根神经节激惹症状；传统组出现1例术中硬膜撕裂，1例术后切口浅表感染，并发症发生率无统计学差异（P>0.05）。术后6月及末次随访ODI、VAS评分两组对比无统计学差异（P>0.05）。末次随访时，植骨融合率无统计学差异（P>0.05）。 结论　与PLIF手术比较，显微镜辅助下MIS-TLIF治疗腰椎单节段退行性病变具有创伤小、近期疗效满意等优点。

Clinical efficacy of MIS-TLIF assisted with microscope in treatment of lumbar single-segment degenerative diseases

Objective　To investigate the safety and efficacy of microscope-assisted minimal invasive posterior transforminal lumbar interbody fusion (MIS-TLIF) in the treatment of single segmental degenerative diseases of lumbar vertebrae.　Methods　Clinical data of 42 patients (minimally invasive group) treated with microscope-assisted MIS-TLIF and 50 patients (traditional group) treated with PLIF were retrospectively analyzed. At the same time perioperative parameters, imaging and clinical efficacy of the two groups were compared.　Results　All patients were followed up, and 1 case of dorsal root ganglion irritation was found in the minimally invasive group. One case of dural tear and one case of superficial wound infection occurred in the traditional group. There was no statistical difference in the incidence of complications between the two groups (P>0.05). The incision length, intraoperative blood loss, postoperative drainage volume, postoperative hospital stay, creatine kinase level of 1 day after surgery, ODI score of 3 months after surgery, VAS score of 1 day after surgery and 3 months after surgery in the minimally invasive group were all lower than that of the traditional group (P<0.05). The operation time and time of intraoperative X-ray irradiation in the minimally invasive group were longer than that of the traditional group (P<0.05). There was no statistical difference between the ODI scores and VAS scores of 6 months after the operation and the last follow-up (P>0.05). At the last follow-up, there was no statistical difference in the rate of bone graft fusion (P>0.05).　Conclusions　Compared with PLIF surgery, microscope-assisted MIS-TLIF has the advantages of less trauma and satisfactory short-term efficacy in the treatment of lumbar degenerative diseases.