75岁以上老年人腰椎微创与开放融合术的围术期比较

摘要

目的：比较S-Tube下腰椎微创经椎间孔椎体间融合术(minimally invasive transforaminal lumber interbody fusion，MIS-TLIF)与传统开放后路腰椎椎体间融合术(posterior lumber interbody fusion，PLIF)治疗75岁以上老年人单节段腰椎退性行疾病的围术期优势。方法回顾性分析2010年6月-2013年6月，接受单节段腰椎融合手术的75岁以上患者45例，20例行MIS-TLIF，25例行PLIF，比较围术期相关指标及并发症。结果两组一般资料比较差异无统计学意义(P＞0.05)；MIS-TLIF组术后发生并发症1例(5%)，PLIF组5例(20%)，但两组间差异无统计学意义(P＞0.05)；MIS-TLIF组钉道制备时间、术中出血量、术后引流量、下地时间和术后住院时间均低于PLIF组(P＜0.01)，两组间手术时间、术中透视时间无统计学差异(P＞0.05)；术后3 d MIS-TLIF组腰痛VAS评分优于PLIF组(P＜0.05)，术后两组间ODI评分、腿痛VAS评分无统计学差异(P＞0.05)，术后评分均明显优于术前(P <0.05)。结论与传统开放PLIF相比，S-Tube下MIS-TLIF术式治疗75岁以上老年人单节段腰椎退行性疾病，具有创伤小、恢复快等优势。%Objective To investigate the perioperative characteristics between minimally invasive transforaminal lumber interbody fusion (MIS-TILF) and posterior lumber interbody fusion (PLIF) in the treatment of single-level lumbar degenerative disease in patients older than 75 years.Methods Clinical data about 45 cases older than 75 years with single-level lumbar degenerative disease who underwent lumber operation from June 2010 to June 2013 were retrospectively analyzed, including 20 cases underwent direct vision MIS-TILF, and 25 cases underwent traditional open PLIF. Comorbidities were investigated before surgery, and the perioperative characteristics were compared between the two groups.ResultsThere were no significant differences in gender, age, lesion location and comorbidities (P>0.05). The mean age of patients in MIS-TLIF group was 77.2±2.0 years while it was 77.8±1.9 years in PLIF group. There were 1 complication with an incidence of 5% in MIS-TILF group and 5 complications with an incidence of 20% in PILF group but no significant difference was found between two groups (P>0.05). There were less blood loss, ambulation time and hospitalization time in MIS-TLIF group than in PLIF group (P<0.01). The back pain VAS of MIS-TLIF group at 3 days postoperative were better than that in PLIF group (P<0.05). No significant differences were observed in postoperative leg pain VAS and ODI scores between the two groups (P>0.05).Conclusion Compared with PLIF, MIS-TLIF has advantages of less trauma and quick recovery in patients older than 75 years with single-level lumbar degenerative disease.