微创和开放TLIF治疗单节段腰椎间盘突出症的比较

目的评价即时三维导航下单节段微创经椎间孔椎体融合术（minimallytransforaminallumbarinterbodyfu．sion，mini—TLIF）与开放后路（openposteriortransforaminallumbarinterbodyfusion，open—TLIF）的短期临床疗效比较。方法2011年10月至2012年2月对40例单节段腰椎间盘突出症患者分别采用即时三维导航下mini—TLIF（20例）和open—TLIF（20例）术式进行对比研究。比较两组手术时间、术中出血量、术后引流量、术后住院时间与总住院时间。视觉模拟评分（visualanaloguescale，VAS）和日本骨科协会（Japaneseorthopaedicassociation，JOA）下腰痛评分评价术后伤口疼痛及功能情况。结果4｜D例均获得随访，mini—TLIF组平均手术时间较open—TLIF组长，差异有统计学意义（P〈0．01），mini—TLIF组总的住院时间、术后住院的时间较open—TLIF组明显缩短，差异有统计学意义（P〈0．01）；mini—TLIF组术中出血量明显较open—rrIJIF组减少，差异有统计学意义（P〈0．05）；术后引流量明显较open—TLIF组减少，差异有统计学意义（P〈0．01）；术后3dmini—THF组腰痛VAS评分的降低更为明显，差异有统计学意义（P〈0．01）；术后3dmini—TLIF组JOA评分同open—TLIF组比较下降更为明显，差异有统计学意义（P〈O．01）。术前、术后6个月两组腰、腿痛VAS评分、JOA评分比较，差异无统计学意义（P〉0．05）。结论即时三维导航下单节段微创TLIF具有术中出血量少、术后引流少、创伤小、住院时间短、短期疗效确切等优点，是一种有效的治疗方法。

Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion in the Treatment of Single - level Lumbar Disc Herniation

Objective To evaluate the short - term effect of minimally invasive transforaminal lumbar interbody fusion （mini -TLIF）with real -time three -dimensional navigation system and open posterior transforaminal lumbar interbodyfusion （ open - TLIF）. Methods From Oct. 2011 to Feb. 2012,40 cases with lumbar disc herniation and need operation of decom- pression pilus fusion randomly underwent mini -TL1F（20）and open -TLIF（20）. The following factors were compared, the op- erative duration, intraoperative blood loss, postoperative drainage volume, the length of postoperative hospital stay and the length of hospital stay. The clinical outcomes were evaluated by the JOA low back pain index and the VAS. Results All patients were followed up regularly （range 6 - 10 months,mean of 7.7 months）. The following factors were compared,The minimal in- vasive group had significantly longer operative duration than the open surgery group,and the length of postoperative hospital stay and the length of hospital stay were significantly shorter in the mini group than in the open surgery group （P 〈 0.01 ） ;the open surgery group had significantly increased postoperative drainage volume compared with the mini group （P 〈 0.01 ） ; the open surgery group had significantly increased intraoperative blood loss compared with the mini group-（ P 〈 0, 05 ）. The VAS and The JOA scores were significantly higher in the mini group than in the open surgery group at 3 days after surgery （ P 〈 0.01 ）, But at preoperative and 6 months postoperative there was no significant difference in the VAS and JOA scores between the two groups（P 〉 0.05）. Conclusion Mini -TLIF using CAOS can effectively reduce intraoperative blood loss, pOstoperative drainage volume, the length of hospital stay, and is an effective method for lumbar disc herniation.