微创经椎间孔腰椎间融合术治疗腰椎椎管狭窄症的效果评价

Evaluation of the efficacy of minimally invasive transforaminal lumbar interbody fusion in treatment of lumbar spinal stenosis

摘要:

目的 探讨微创经椎间孔腰椎间融合术（Mis-TLIF）治疗腰椎椎管狭窄症的临床效果。方法 回顾性分析2014年1月－2019年1月83例在该院住院的腰椎椎管狭窄症患者的临床资料，按手术方法不同分为Mis-TLIF组（n = 40）和腰椎后路椎间融合（PLIF）组（n = 43）。Mis-TLIF组腰椎椎管狭窄原因：腰椎滑脱15例，腰椎间盘突出13例，小关节增生12例；PLIF组腰椎椎管狭窄原因：腰椎滑脱18例，腰椎间盘突出15例，小关节增生10例。对比两组患者围术期指标，采用视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评估患者术后第1天、术后1、3、6和12个月腰部疼痛情况。结果 Mis-TLIF组手术时间（109.4±10.4）min、切口长度（8.2±1.3）cm和术后卧床（2.4±1.1）d明显短于PLIF组的（141.5±12.2）min、（15.8±1.6）cm和（3.5±2.8）d，Mis-TLIF组术中出血量和术后引流量分别为（511.9±49.7）和（101.6±31.3）mL，均明显少于PLIF组的（697.4±55.2）和（305.5±77.1）mL。Mis-TLIF组术后各时间段VAS及ODI均低于PLIF组，两组比较，差异有统计学意义。术后随诊，Mis-TLIF组与PLIF组术后融合指标（术后内固定松动例数+CT复查骨桥形成例数）比较，差异无统计学意义。结论 Mis-TLIF治疗腰椎椎管狭窄症，在手术时间、术中出血量、住院时间、术后功能恢复等方面均优于PLIF，但应严格掌握手术适应证，避免不良事件发生。

Abstract:

Objective To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) in treatment of lumbar spinal stenosis.Methods The clinical data of 83 patients with lumbar spinal stenosis from January 2014 to January 2019 were retrospectively analyzed, the patients were divided into Mis-TLIF group (n = 40) and posterior lumbar interbody fusion (PLIF) group (n = 43) by different surgical methods. The causes of lumbar spinal stenosis in Mis-TLIF group: lumbar spondylolisthesis of 15 cases, lumbar disc herniation of 13 cases, facet hyperplasia of 12 cases. The causes of lumbar spinal canal stenosis in PLIF group: lumbar spondylolisthesis of 18 cases, lumbar disc herniation of 15 cases, facet hyperplasia of 10 cases. Perioperative indicators, visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 day, 1 3, 6, and 12 months after surgery were compared between the two groups.Results The operation time was (109.4 ± 10.4) min, length of incision was (8.2 ± 1.3) cm and postoperative bed rest time was (2.4 ± 1.1) d in Mis-TLIF group, they were significantly shorter than those in PLIF group [(141.5 ± 12.2) min, (15.8 ± 1.6) cm and (3.5 ± 2.8) d]. The intraoperative blood loss was (511.89 ± 49.7) mL and postoperative drainage was (101.6 ± 31.3) mL in Mis-TLIF group, they were significantly lower than those in PLIF group [(697.4 ± 55.2) and (305.5 ± 77.1) mL]. The VAS and ODI in Mis-TLIF group were lower than those in PLIF group at postoperative periods, and the difference was statistically significant. Postoperative follow-up, there was no significant difference in postoperative melting index (number of postoperative loosening of internal fixation+number of bone bridge formation in CT review) between the two groups.Conclusion Mis-TLIF is superior to PLIF in treatment of lumbar spinal stenosis in terms of operative time, intraoperative blood loss, length of hospital stay, postoperative functional recovery, etc, but the operative indications should be strictly controlled to avoid the occurrence of adverse events.