Objective To observe the mid-and long-term clinical efficacy of minimally invasive transforaminal lumbar interbody fusion for the treatment of single-segment lumbar degenerative diseases. Methods Retrospective analysis of the clin-ical data of 832 patients with lumbar degenerative disease treated with single-segment MIS-TLIF surgery from 2007 to 2013, 443 males and 389 females; aged 23-82 years, mean 56.4±18.7 years old. All cases were divided into revision surgery group, severe lumbar spinal stenosis group, moderate to severe lumbar spondylolisthesis group and general case groups (as a control) for comparative analysis. Efficacy evaluation indicators include Oswestry disability index (ODI), visual analog scale (VAS), in-tervertebral fusion rate, and complications. Results All patients were followed up for 62 to 93 months, with an average of 79.2±18.6 months. One month after operation, the VAS score of low back pain in the severe spinal stenosis group 2.9±0.5 and the moderate to severe spondylolisthesis group 3.8±1.1 were both significantly higher than the general case group 1.6±0.6, and the difference was statistically significant. The VAS score of leg pain was high in the moderate to severe slip group 2.6 ± 0.7, but the difference was not statistically significant. The ODI value was significantly higher in the moderate to severe spoiler group 28.8±6.9％ than in the general case group 22.1±6.4％. In the 2 years after the operation, the vas of lower back pain was divided into 2.4 ± 0.9, compared with the general case group 1.7 ± 0.5, and the difference was statistically significant; the ODI group of severe spinal stenosis and moderate-severe spondylolisthesis were 17.9％± 3.4％ and 19.4％± 4.9％, respectively, which was higher than the general case group 11.3％±3.3％, and the difference was statistically significant. In the last follow-up, the VAS scores 2.3±0.8 and 2.6±1.1 of the severe vertebral canal stenosis group and the moderate-severe spondylolisthesis group were respectively higher than that of the general case group 1.6±0.7, and the difference was statistically significant; the ODI group of severe vertebral canal stenosis and moderate-severe spondylolisthesis were 18.3％±11.1％ and 19.6％±12.1, high-er than the general case group 11.8％± 9.7％, the difference was statistically significant. The incidence of mid- and long-term complications (intervertebral non-fusion, adjacent segment disease) was not statistically significant among the four groups. Con-clusion MIS-TLIF treatment of lumbar degenerative diseases can obtain good medium and long-term clinically effect. For complex diseases such as revision, severe degeneration and moderate to severe spondylolisthesis, MIS-TLIF did not increase the incidence of medium and long-term complications.%目的 探讨微创经椎间孔腰椎椎间融合术(minimally invasive surgery-transforaminal lumbar interbody fusion,MIS-TLIF)治疗单节段腰椎退变性疾病的中远期临床疗效.方法 回顾性分析2007年至2013年采用单节段MIS-TLIF手术治疗832例腰椎退变性疾病患者的病历资料,男443例,女389例;年龄23～82岁,平均(56.4±18.7)岁.分为翻修手术组、重度腰椎管狭窄症组、中重度腰椎滑脱症组及一般病例组(作为对照)进行对比分析.疗效评价指标包括Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟评分(visualanalogue scale,VAS)、椎间融合率及并发症发生情况.结果 所者患者均得到随访,随访时间62～93个月,平均(79.2±18.6)个月.术后1个月,重度椎管狭窄症组及中重度滑脱症组腰痛VAS评分分别为(2.9±0.5)分及(3.8±1.1)分,较一般病例组(1.6±0.6)分高,差异均有统计学意义;中重度滑脱组下肢痛VAS评分为(2.6±0.7)分相较其他三组高,但差异无统计学意义;中重度滑脱组ODI为28.8％±6.9％较一般病例组22.1％±6.4％高,差异有统计学意义.术后2年,中重度滑脱症组腰痛VAS评分为(2.4±0.9)分,较一般病例组(1.7±0.5)分高,差异有统计学意义;重度椎管狭窄症组及中重度滑脱症组ODI分别为17.9％±3.4％及19.4％±4.9％较一般病例组11.3％±3.3％高,差异有统计学意义.末次随访,重度椎管狭窄症组及中重度滑脱症组腰痛VAS评分分别为(2.3±0.8)分及(2.6±1.1)分,较一般病例组(1.6±0.7)分高,差异均有统计学意义;重度椎管狭窄症组及中重度滑脱症组ODI分别为18.3％±11.1％及19.6％±12.1％较一般病例组11.8％±9.7％高,差异有统计学意义.翻修手术组、重度腰椎管狭窄组以及中重度腰椎滑脱症组硬膜撕裂风险较一般病例组增加,重度椎管狭窄组神经损伤风险相对增加.中远期并发症(椎间不融合、邻椎病)发生率四组间的差异无统计学意义.结论 MIS-TLIF手术治疗腰椎退变性疾病可获得良好的中远期疗效,对于复杂病例如翻修、重度腰椎管狭窄症以及中重度滑脱症患者并未增加中远期并发症发生率.
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