显微镜辅助下微创经椎间孔椎间融合术治疗单节段腰椎退变性疾病的临床疗效

目的探讨显微镜辅助下微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗单节段腰椎退变性疾病的临床疗效及安全性。方法回顾性分析2017年1月至2018年1月我院收治的73例腰椎退变性疾病病人的临床资料,其中行Loupe辅助下MISTLIF的40例纳入Loupe组,行显微镜辅助下MIS-TLIF的33例纳入显微镜组。比较两组病人手术前后腰腿部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、手术时间、手术切口长度、射线暴露次数、术中出血量、术后引流量、术后下地时间、术后住院时间、术后椎间植骨融合率、并发症情况以及住院相关费用等。结果两组病人均完成至少2年的随访,随访时间为(27.5±2.6)个月(24~36个月)。两组病人的手术时间、切口长度、射线暴露次数、术中出血量、腰腿痛VAS评分、ODI、椎间植骨融合率、住院费用以及并发症发生率比较,差异均无统计学意义(P均>0.05)。显微镜组有1例置钉失败病人。两组术后各有1例出现神经根激惹,各有1例浅表性切口感染,局部缝线崩开。显微镜组术后引流量、术后下地时间以及术后住院时间均少于Loupe组,差异均有统计学意义(P均<0.05)。显微镜组术后术者颈部VAS评分明显低于Loupe组(P<0.05),但腰部VAS评分较Loupe组高(P<0.05)。结论显微镜辅助下MIS-TLIF治疗腰椎退行性疾病较Loupe辅助下MIS-TLIF具有更彻底的术中止血、更少的术后引流量、更早下地和更快出院以及明显改善术者术后颈部不适等优势,近期临床疗效相当。

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

Objective To discuss the clinical efficacy as well as safety of microscope-assisted lumbar degenerative diseases.Methods Data of 73 cases of lumbar degenerative diseases from January 2017 to January 2018 admitted at our hospital were analyzed retrospectively,among which,40 cases undergoing the treatment of Loupe-assisted MIS-TLIF served as Loupe group,and 33 cases given the treatment of microscopeassisted MIS-TLIF as microscope group.Different parameters were compared between the two groups,including visual analogue scale(VAS)of low back pain and leg pain before and after operation,Oswestry disability index(ODI),operation time,surgical incision,radiation exposure times,intraoperative blood loss,postoperative drainage,postoperative landing time,postoperative hospital stay,postoperative interbody fusion rate,complications,hospitalization expenses.Results All patients in both two groups were followed up for at least 2 years,with a follow-up period of(27.5±2.6)months(24-36 months).There was no significant difference between the two groups in operation time,incision length,radiation exposure times,intraoperative blood loss,VAS score of low back pain and leg pain,ODI,fusion rate,hospitalization expenses and complications(all P>0.05).There was 1 case of failed nail placement in the microscope group,1 case of symptoms of nerve root irritation in each group and 1 case of superficial incision infection and local suture collapse in each group.The postoperative drainage volume,postoperative landing time and postoperative hospital stay in microscope group were significantly decreased as compared with those in Loupe group(all P<0.05).The postoperative neck discomfort in the microscope group was significantly alleviated compared to Loupe group(P<0.05),but the waist discomfort in the microscope group was slightly increased compared to the Loupe group(P<0.05).Conclusion Compared with Loupe-assisted MIS-TLIF in the treatment of lumbar degenerative disease,microscope-assisted MIS-TLIF has the advantages like more thorough intraoperative hemostasis,less postoperative drainage,earlier landing time as well as faster discharge time,and significant improvement of postoperative neck discomfort of patients.Additionally,the short-term clinical efficacy of these two groups was similar.