经通道下改良微创经椎间孔腰椎椎体间融合术( TLIF )治疗腰椎间盘突出症疗效观察

摘要

Objective To compare clinical outcomes of modified transforaminal lumbar interbody fusion ( TLIF) with or without Quad-rant retractor for lumbar disc herniation .Methods Totally 50 cases suffered from single lumbar disc herniation with segmental instability , in which 24 cases were treated by modified TLIF via MAST Quadrant retractor ( minimally invasive group ) ,26 cases were operated without MAST Quadrant retractor ( compare group ) .The blood loss during operation , postoperative drainage , operation time , hospital day , visual analogue scores( VAS) and Japanese Orthopaedic Association ( JOA) scores before operation and the last follow -up, improvement rate of JOA between two groups were compared .Results All cases were followed up from 6 to 12 months.The VAS were lower and JOA scores were higher at last follow-up than preoperative ones in two groups , the difference was significant (P<0.05) .The MAST Quadrant retractor group had less blood loss during operation , less postoperative drainage , shorter operation time , shorter hospital day , lower VAS , higher JOA scores and im-provement rate than the compared group , the difference was significant ( P<0.05) .Conclusion Modified TLIF with or without MAST Quad-rant retractor for lumbar disc herniation with segmental instability both can achieve a good efficiency , the former has the advantages of less pa-raspinal muscle damage and blood loss , shorter hospitalization time , less postoperative lumbar pain , faster postoperative recovery .%目的 探讨经通道下改良微创TLIF与非通道下传统TLIF治疗腰椎间盘突出症的临床效果. 方法 50例单节段腰椎间盘突出症伴节段不稳患者中,24例采用经通道下改良微创TLIF(改良微创组) ,26例采用传统TLIF(对照组) ,比较2组的术中出血量、术后引流量、手术时间、住院时间、住院费用、术前及术后腰、腿痛VAS评分、JOA 评分及改善率. 结果 50例均获随访,时间6~12个月,末次随访时2组VAS和JOA评分较术前均明显改善,差异有统计学意义( P <0.05). 微创组术中出血量、术后引流量、住院时间、末次随访时腰痛VAS评分、JOA评分及改善率等方面均优于对照组,差异有统计学意义(P <0.05). 结论 经通道下改良微创TLIF与非通道下传统TLIF治疗单节段腰椎间盘突出症均可取得满意的临床疗效,前者具有创伤小、出血少、住院时间短、术后残留腰痛少、恢复快等优点.