两种手术方式治疗L5~S1腰椎退变性疾病疗效比较

摘要

目的：比较微创通道下经椎间孔腰椎融合术(MIS-TLIF)与传统的腰椎后路融合术(PLIF)治疗腰椎退变性疾病的临床疗效。方法选取2013年12月至2014年8月在我院脊柱外科行L5~S1单节段手术的腰椎退行性疾病患者84例，其中MIS-TLIF组38例，PLIF组46例，术后随访12~20个月，平均15.8个月，比较两组患者的手术时间、术中射线照射时间、术中出血量、术后引流量、术后下地时间、住院时间、视觉模拟评分(VAS)和腰椎功能评分(JOA)等。结果两组患者的年龄、性别、临床诊断比较差异均无统计学意义(P>0.05)；MIS-TLIF组与PLIF组相比，手术时间(122 h vs 136 h)、术中出血(115 mL vs 151 mL)、术后引流(0 mL vs 140 mL)、术后下地时间(25 h vs 42 h)、住院时间(3.6 d vs 5.2 d)明显减少，术中射线照射时间(15 s vs 11.6 s)明显延长，差异均有统计学意义(P<0.05)。MIS-TLIF组患者术后出院时VAS腰痛评分为(3.8±2.3)分，明显优于PLIF组的(4.9±4.2)分，差异有统计学意义(P<0.05)。术后3个月及末次随访，MIS-TLIF组与PLIF组相比，VAS评分(术后3个月：2.1分vs 2.5分；末次随访：1.3分vs 1.5分)及JOA评分(术后3个月：19.2分vs 18.9分；末次随访：24.6分vs 25.1分)均较术前明显改善(P<0.05)，但两组间比较差异均无统计学意义(P>0.05)。MIS-TLIF组与PLIF组末次随访的临床疗效的优良率分别为92.1%和91.3%，差异无统计学差异(P>0.05)。结论 MIS-TLIF术式对L5~S1节段腰椎退行性疾病有确切的手术优势，临床医生可根据个人技术水平及器械配备合理选择该手术方式。%Objective To compare the clinical effect of minimally invasive surgery transforaminal lumbar inter-body fusion (MIS-TLIF) and posterior lumbar interbody fusion (PLIF) in treatment of L5~S1 degenerative lumbar spine disease. Methods A total of 84 patients with L5~S1 degenerative lumbar spine disease (38 patients for MIS-TLIF, 46 pa-tients for PLIF), who admitted to Department of Spinal Surgery in our hospital from December 2012 to August 2014, were selected as the subjects. The average follow-up time for these patients was 15.8 months (range, 12~20 months). The time of surgery, blood loss, time of standing recovery, hospital time, X-ray exposure, postoperative drainage volume, vi-sual analogue score (VAS) and Japanese Orthopedic Association (JOA) scores of MIS-TLIF group and PLIF group were compared. Results There were no differences between the MIS-TLIF group and PLIF group in age, gender and clinical diagnosis (P>0.05). Compared with PLIF group, MIS-TLIF group had significantly shorter operative time (122 h vs 136 h), less blood loss (115 mL vs 151 mL), less postoperative drainage volume (0 mL vs 140 mL), shorter postoperative bed time (3.6 d vs 5.2 d) and longer X-ray exposure time (15 s vs 11.6 s), all with P<0.05. After discharged from hospital, the VAS scores of low back pain in MIS-TLIF group [(3.8 ± 2.3) points] was significantly shorter than that in PLIF group [(4.9±4.2) points] (P<0.05). After 3 months of surgery and final follow-up, there were no significant differences between MIS-TLIF group and PLIF group in VAS scores [3 months post operation:2.1 points vs 2.5 points;Final follow-up:1.3 points vs 1.5 points) (P>0.05) and JOA scores (3 months post operation:19.2 points vs 18.9 points;Final follow-up:24.6 points vs 25.1 points) (P>0.05), while which were significantly better than preoperative scores in two groups (P<0.05). There was no significant difference between MIS-TLIF group (92.1%) and PLIF group (91.3%) in the clinical curative effects of final follow-up. Conclusion MIS-TLIF has the advantages of surgery in L5~S1 lumbar degenerative disease, so we can choose the reasonable surgical procedure according to individual skill levels and instruments.