微创TLIF单侧置钉与传统TLIF双侧置钉的前瞻性对比研究

摘要

Objective To compare the clinical outcomes of MIS-TLIF with unilateral fixation and TLIF with bilateral fixation for lumbar degenerative disease.Methods From June 2014 to December 2015,79 patients with lumbar degenerative disease were treated in our hospital.Patients were divided into two groups according to different surgery methods.36 patients underwent MIS-TLIF with unilateral pedicle screw fixation (unilateral group),while 43 patients underwent conventional TLIF with bilateral pedicle screw fixation (bilateral group).Operation time,intraoperative blood loss,and postoperative hospital stay were recorded.Pre-and post-operative visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the clinical outcomes.Results All patients underwent operation successfully.The unilateral group had significantly shorter operation time and less intraoperative blood loss than the bilateral group (P<0.05).There was no significant difference in postoperative hospital stay between two groups (P>0.05).Patients were followed up for 12~30 months.There were no significant differences in VAS and ODI scores between two groups before surgery (P>0.05).After surgery,all the patients underwent significant differences with respect to the improvement of VAS and ODI scores (P<0.05).At the last follow-up,there were no significant differences in VAS and ODI scores between two groups (P>0.05).Conclusion Based on this study,MIS-TLIF with unilateral fixation could achievesimilar clinical outcomes to conventional TLIF with bilateral fixation,but resulted in shorter operation time and less intraoperative blood loss.%目的 比较微创经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)单侧置钉与传统TLIF双侧置钉治疗腰椎退行性疾病的临床疗效.方法 2014年6月至2015年12月,我院收治腰椎退行性疾病患者79例,分为单侧固定组和双侧固定组.单侧固定组接受微创TLIF联合单侧椎弓根螺钉内固定治疗,共36例;双侧固定组接受传统TLIF联合双侧椎弓根螺钉内固定治疗,共43例.记录并比较两组的手术时间、术中出血量、术后住院时间,采集并比较两组患者术前、术后腰痛、下肢痛疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评分.结果 两组患者均顺利接受手术,单侧固定组较双侧固定组手术时间更短,术中出血量更少,差异均有统计学意义(P<0.05);两组患者术后住院时间比较,差异无统计学意义(P>0.05).两组患者随访12~30个月.术前两组患者腰痛、下肢痛VAS评分及ODI评分比较,差异无统计学意义(P>0.05).末次随访时两组患者腰痛、下肢痛VAS评分及ODI评分均较术前明显降低,差异有统计学意义(P<0.05);两组间比较,腰痛、下肢痛VAS评分及ODI评分差异均无统计学意义(P>0.05).结论 本试验显示微创TLIF单侧置钉与传统TLIF双侧置钉相比,能够取得与后者类似的临床疗效,但能明显降低手术时间及术中出血量.