微创经椎间孔椎间融合术联合单、双侧内固定治疗单间隙腰椎退变性疾病

摘要

目的 探讨微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)联合单侧或双侧内固定治疗单节段腰椎退行性疾病的临床及影像学疗效.方法 回顾性分析2009年10月至2011年12月期间,采用METRx-MD(Microscopic Endoscopic Tubular Retractor System)进行MIS-TLIF治疗单节段腰椎退行性疾病并获得长期随访的65例患者的相关资料.根据内固定方式分为两组,单侧固定组(31例)采用MIS-TLIF联合单侧内固定技术,双侧组(34例)采用MIS-TLIF联合双侧经皮内固定技术.采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价腰椎功能情况,采用疼痛视觉模拟评分(visual analogue scale,VAS)分别对腰痛及下肢痛进行评估;在X线片上测量手术前后的腰椎前凸角度、手术节段前凸角度、腰椎侧凸角度、手术节段侧凸角度,计算腰椎前凸指数及椎间高度指数.结果 所有患者均顺利完成手术,术后随访18～36个月,平均26.6个月.所有患者术后12个月均获得骨性融合.两组患者术后VAS及ODI评分均较术前有明显改善,两组间术前及随访期间VAS及ODI评分的差异无统计学意义.影像学测量结果显示两组间腰椎前凸角度、手术节段前凸角度、腰椎侧凸角度、手术节段侧凸角度、腰椎前凸指数及椎间高度指数的差异均无统计学意义,腰椎前凸角度与腰椎前凸指数呈线性相关.结论 对于治疗单间隙腰椎退变性疾病,MIS-TLIF联合单侧或双侧经皮内固定技术具有相似的临床及影像学疗效.%Objective To explore the clinical and radiographic outcomes of minimally invasive transforarninal lumbar interbody fusion (MIS-TLIF) with unilateral pedicle screw fixation in treatment of one-level lumbar degenerative disease.Methods A total of 65 patients suffered from one-level lumbar degenerative disease between October 2009 and December 2011.They were divided into 2 groups according to different fixation ways.31 patients were given MIS-TLIF with unilateral pedicle screw fixation.The other 34 patients were given MIS-TLIF with bilateral pedicle screw fixation.Microscopic tubular retractor system (METRxMD) and Sextant system were used in all the procedures of treatment.The whole lumbar lordosis (WL),the segmnental lordosis (SL),fusion level disc space angle,lumbar scoliosis angle,and segmental scoliosis angle were measured pre and post operation according to standarded X-rays.The disc height index (DI) and the lumber curvature index (LI) were also evaluated.The Oswestry disability index (ODI) score and visual analog scale (VAS) pain score data were obtained from all the patients pre-operation and during each following-up procedure.Results All the patients were well followed up 18 months to 36 months(average 26.6 months).All the 65 patients were proved to achieve bone fusion in 12 months post-operation.The ODI and VAS scores post-operation improved significantly in each group,but showed no significant difference between the 2 groups.Likewise,there were no significant differences between the 2 groups in datas of WL,SL,fusion level disc space angle,lumbar scoliosis angle,segmental scoliosis angle,DI,and LI.But there was a positive linear correlation between the LI and WL in the 2 groups.Conclusion MIS-TLIF with unilateral pedicle screw fixation is as good as MIS-TLIF with bilateral pedicle screw fixation in patients of one-level lumbar degenerative disease.