Quadrant通道下改良微创TLIF术与常规微创TLIF术治疗单间隙腰椎间盘突出症的临床比较

摘要

目的 比较分析Quadrant通道下改良微创经椎间孔椎体间融合技术(TLIF)与常规微创TLIF治疗单间隙腰椎间盘突出症的临床疗效.方法 随机数字表格法将80例单间隙腰椎间盘突出症患者分为改良组与常规组,分别行Quadrant通道下改良微创TLIF术、常规微创TLIF术,比较两组围手术期指标、并发症、手术前后疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)变化,另术后12个月根据改良Macnab标准评价临床疗效.结果 改良组手术时间、切口长度均显著小于常规组(P＜0.05);两组术中出血量、术后引流量、术后下地活动时间、住院时间、并发症发生比较差异均无统计学意义(P＞0.05);两组术后1周、12个月VAS评分比术前24 h均显著下降,ODI评分显著上升,差异有统计学意义(P＜0.05);改良组术后1周VAS评分显著低于常规组(P＜0.05);两组术后12个月VAS评分、ODI评分、改良Macnab评价优良率比较差异均无统计学意义(P＞0.05).结论 相比常规微创TLIF术,Quadrant通道下改良微创TLIF术能明显缩短手术时间,切口更小,术后短期疼痛更轻.%Objective To compare the clinical efficacy of modified minimally invasive transforam-inal lumbar interbody fusion (TLIF) under Quadrant channel and conventional minimally invasive TLIF in the treatment of single-level lumbar disc herniation. Methods Eighty patients with single-level lumber disc herniation were randomly divided into the modified group and the conventional group, and they were treated by modified minimally invasive TLIF under Quadrant channel and conventional mini-mally invasive TLIF, respectively. Perioperative indicators, complications, changes in visual analogue scale (VAS) scores and Oswestry dysfunction index (ODI) before and after operation were compared be-tween the two groups. The clinical efficacy was evaluated at 12 months after operation according to the modified Macnab criteria. Results The operation time and length of incision of the modified group were significantly shorter than those of the conventional group (P＜0.05). There were no significant dif-ferences between the two groups in the intraoperative blood loss, postoperative drainage volume, post-operative ambulation time, length of hospital stay and incidence of complications (P＞0.05). VAS scores in the two groups at 1 week and 12 months after operation were significantly lower than at 24 h before operation, while ODI scores were significantly higher than at 24h before operation (P＜0.05). The VAS score in modified group at 1 week after operation was significantly lower than that in conventional group (P＜0.05). There were no significant differences between the two groups in VAS scores, ODI scores and the excellent and good rate of modified Macnab evaluation at 12 months after operation (P＞0.05). Conclusion Compared with conventional minimally invasive TLIF, the modified minimally in-vasive TLIF under Quadrant channel can obviously shorten the operation time, the incision is smaller, and the postoperative short-term pain is milder.