Wiltse入路微创与开放经椎间孔椎间融合术治疗腰椎退行性疾病的比较

目的 比较Wiltse入路微创经椎间孔椎间融合术(MIS-TLIF)与开放经椎间孔椎间融合术(TLIF) 治疗腰椎退行性疾病的临床疗效。方法 回顾性分析2011年3月—2014年6月南京医科大学附属无锡人民医院骨科,因单节段腰椎退行性疾病分别行Wiltse入路MIS-TLIF(MIS-TLIF组)和开放TLIF(TLIF组)治疗的82例患者临床资料,其中MIS-TLIF组36例,TLIF组46例。比较两组手术时间、术中出血量、术后下床活动时间、术后并发症发生率、术后1年椎间融合率,以及术前和术后第1、3天肌酸激酶(CK)水平,术前及术后1年疼痛VAS评分及ODI。结果 MIS-TLIF组平均手术时间、术中出血量、术后下床活动时间、术后第3天CK水平均少/低于开放TLIF组,差异均有统计学意义( P值均＜0.01) 。术后两组并发症发生率及术后1年椎间融合率差异均无统计学意义(P值均＞0.05) 。术后1年两组VAS评分、ODI功能障碍指数均较术前降低,差异均有统计学意义(P值均＜0.01) ,术前及术后1年两组间差异均无统计学意义(P值均＞0.05) 。结论 Wiltse入路微创腰椎椎体间融合手术是治疗腰椎退变性疾病的有效方法,并能减少手术创伤及术中出血量,使得患者可以早期康复。

Comparison of minimally invasive and open transforaminal lumbar interbody fusion through Wiltse approach and conventional approach in the treatment of degenerative lumbar disease

Objective To compare clinical result of minimally invasive transforaminal lumbar interbody fusion(TLIF) and open TLIF through Wiltse approach and conventional approach in treatment of degenerative lumbar disease.Methods Thirty-six and 46 patients of Wuxi People′s Hospital who underwent minimally invasive TLIF (MIS-TLIF) through Wiltse approach and TLIF through conventional approach separately were selected. The operating time, blood loss, creatine kinase, the leaving bed time, postoperative complications, and intervertebral fusion rate were recorded. The function of lumbar and legs was evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI). The operating time, blood loss, creatine kinase, the leaving bed time, postoperative complications, intervertebral fusion rate were compared between MIS-TLIF group and TLIF group. VAS and ODI were compared between MIS-TLIF group and TLIF group pre- and post-operatively.Results The operating time, blood loss, postoperative creatine kinase (3 days), the leaving bed time in the MIS-TLIF group were significantly less than those in the group of TLIF(all P values<0.01) . The rate of complication and intervertebral fusion at 1 year between two groups wasn′t significantly different (all P values>0.05). VAS and ODI of 1 year were significantly lower than preoperative in both groups (all P values<0.01), however, there were no significant differences neither at preoperative or final follow-up between groups (all P values>0.05).Conclusions MIS-TLIF is an effective way to treat degenerative lumbar disease. It can reduce the operation wound, hemorrhage during operation and promote early rehabilitation of patients.