微创脊柱内镜系统辅助下行改良经孔椎体间融合术治疗急慢性腰椎间盘损伤性腰椎疾病的临床疗效观察

目的：探究微创脊柱内镜系统辅助下的改良经孔椎体间融合术(transforaminal lumbar interbody fusion， TLIF)治疗急、慢性腰椎间盘损伤性腰椎疾病的临床治疗效果。方法：本次实验所选取的研究对象为我院从2014年2月至2015年10月接诊的84例腰椎疾病的患者，根据患者的档案纳入顺序和患者的意愿，随机将患者分成观察组和对照组，每组有42例患者。观察组的患者进行微创脊柱内镜系统辅助下的改良TLIF治疗，对照组的患者进行开放脊柱内镜系统辅助下的改良TLIF治疗。对两组患者的手术时间、术中的出血量、术后的引流量、术后的下地时间和术后的并发症的发生率进行统计和比较，同时观察并比较两组患者在手术前后Oswestry功能障碍指数(Oswestry disability index，ODI)、视觉模拟评分法(visual analogue scale，VAS)对患者疼痛的评分和患者椎间植骨的融合情况进行比较。结果：两组患者所需要的手术时间无显著性差异(P>0.05)；观察组患者的术中出血量、术后的引流量、术后的下地时间显著低于对照组的患者(P<0.05)；两组患者在术后6个月的植骨融合率无明显差异(P>0.05)；手术前两组患者的VAS评分和ODI评分无显著性差异(P>0.05)；手术1周后，两组患者的VAS和ODI评分显著低于手术前(P<0.05)，并且术后1周后观察组患者的VAS和ODI评分显著低于治疗组(P<0.05)；两组患者的VAS和ODI评分在术后6个月无明显差异(P>0.05)；两组患者均无出现椎间隙感染和神经根损伤等并发症。结论：对于急、慢性腰椎间盘损伤性腰椎疾病的患者，微创脊柱内镜系统辅助下行改良TLIF治疗，患者具有手术创伤小、术中出血少和术后恢复快的临床特点，远期可获得与传统的开放手术相同的临床效果，故微创脊柱内镜系统辅助下的改良TLIF治疗值得临床上推广使用。

Clinical observation of minimally invasive spinal endoscopy assisted by transforaminal lumbar interbody fusion in the treatment of acute and chronic lumbar intervertebral degenerative lumbar disease

Objective:To explore the clinical therapeutic effect of modified transforaminal lumbar interbody fusion (TLIF) in the treatment of acute and chronic lumbar intervertebral degenerative lumbar spine disease with the aid of minimally invasive spine endoscope system. Methods:hTe research objects of this experiment selected 84 cases of lumbar diseases in our hospital from February 2014 to October 2015 admissions of patients. In accordance to the order of the patient’s ifle included and the patient’s will, the patients were randomly divided into observation group and control group, and there were 42 patients in each group. Patients in the observation group were treated with minimally invasive endoscopic system assisted TLIF therapy, and patients in the control group were treated with modified TLIF therapy with open spinal endoscopy. The operation time, blood loss, postoperative drainage volume, postoperative drainage time and postoperative complications were compared between the two groups. At the same time observed and compared Oswestry disability index (ODI), visual analog scale (VAS) pain scores and fusion of intervertebral bone graft in patient of the two groups before and after surgery. Results:There was no significant difference in the operation time between the two groups (P>0.05). hTe amount of bleeding, postoperative drainage, and lower time in the observation group were signiifcantly lower than those in the control group (P<0.05). hTere was no signiifcant difference in bone gratf fusion rate between the two groups atfer operation of 6 months (P>0.05). hTere was no signiifcant difference in the VAS score and ODI score between the two groups (P>0.05). Atfer 1 week of operation, the VAS and ODI scores of the two groups were significantly lower than those before the operation (P<0.05). And atfer 1 week of operation, the VAS and ODI scores of the observation group were signiifcantly lower than those in the treatment group (P<0.05). hTere was no signiifcant difference in the VAS and ODI scores between the two groups after 6 months of operation (P<0.05). There were no complications such as intervertebral space infection and nerve root injury in the two groups. Conclusion:For patients with acute and chronic lumbar disease lumbar spine injury, minimally invasive spinal endoscopy assisted by TLIF treatment, patients having surgical trauma, less blood loss and rapid recovery of the clinical features, the long-term availability of traditional open surgery the same clinical effect, it is minimally invasive endoscopic spine system improvement TLIF assisted therapy worthy of clinical using.