脊柱微创通道镜系统辅助下行TLIF术治疗腰椎退行性疾病的疗效

摘要

Objective To investigate the clinical effect of spinal minimally invasive pathway mirror system assisted downstream TLIF surgery in the treatment of lumbar degenerative diseases.Methods Ninety-four cases of patients with lumbar degenerative diseases were selected,which were treated in hospital from May 2013 to May 2016,and they were divided into the observation group (47 cases) and control group (47 cases).The patients of observation group were treated with spinal minimally invasive pathway mirror system assisted downstream TLIF surgery,while the patients of control group were treated with open TLIF surgery.After surgery,the patients of two groups were routinely placed drainage tube,given antibiotics,dehydrating agents or hormones.The general surgical conditions,clinical effects,complications and the changes of VAS,JOA,ODI scores of two groups before and 2 weeks after operation were observed and compared.Results After the appropriate treatment,the incision length,intraoperative blood loss,postoperative drainage,VAS and ODI scores of observation group were significantly lower than those of control group,the surgery time,JOA score of observation group were significantly higher than those of control group (t =19.289,t =5.921,t =9.368,t =2.987,t =4.759,t =2.157,t =7.058;P＜ 0.05);the total effective rate was 91.5％ (43/47) in the observation group and 87.2％ (41/47) in the control group,the effect is quite similar (x2 =0.448;P ＞ 0.05);There were oral exudate,superficial infection,limb numbness,cerebrospinal fluid leakage,dural sac tear and other adverse reactions occurred in both two groups,and the incidence of complications in the observation group was lower than that in the control group (x2 =6.474;P ＜ 0.05).Conclusion Spinal minimally invasive pathway mirror system assisted downstream TLIF surgery is effective in treating lumbar degenerative diseases,which can improve lumbar dysfunction with small trauma,and improve postoperative recovery of lumbar dysfunction.%目的 观察脊柱微创通道镜系统辅助下行经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎退行性疾病的疗效.方法 选取2013年5月-2016年5月广西医科大学附属民族医院骨科收治腰椎退行性疾病患者94例作为研究对象,按随机数字表法分为观察组47例和对照组47例.观察组采用脊柱微创通道镜系统辅助下行TLIF术;对照组采用开放式TLIF手术方式,2组患者术后常规放置引流管,给予抗生素、脱水剂或激素.比较2组患者一般手术情况、临床效果,分别于术前、术后2周对VAS、JOA、ODI进行评分,并记录2组患者的并发症发生情况.结果 观察组切口长度、术中出血量、术后引流量及治疗后VAS、ODI评分明显低于对照组,而手术时间、治疗后JOA评分显著高于对照组(t=19.289、5.921、9.368、2.987、4.759、2.157、7.058,P＜0.05);观察组总有效率为91.5％ (43/47),对照组为87.2％(41/47),2组比较差异无统计学意义(x2 =0.448,P＞0.05);观察组术后发生术口渗液、浅表感染、患肢麻木、脑脊液漏、硬膜囊撕裂等并发症发生率10.6％明显低于对照组44.7％(x2=6.474,P＜0.05).结论 脊柱微创通道镜系统辅助下行TLIF术治疗腰椎退行性疾病临床效果确切,可改善腰椎功能障碍,创伤小,有利于改善腰椎功能障碍,术后恢复,安全可靠,值得临床推广应用.