微创经椎间孔腰椎椎体间融合术与后路腰椎椎体间融合术治疗复发性腰椎间盘突出症的效果比较

摘要

目的 比较微创经椎间孔腰椎椎体间融合术(MIS-TLIF)与后路腰椎椎体间融合术(PLIF)治疗复发性腰椎间盘突出症(LIDP)的临床效果.方法 回顾性分析2014年5月至2016年5月潍坊市人民医院收治的29例复发性LIDP患者的临床资料,其中行MIS-TLIF 13例(MIS-TLIF组),行PLIF 16例(PLIF组).比较2组患者的手术切口长度、术中失血量、术后引流量、住院时间及并发症情况.术后1 a采用日本骨科协会评分(JOA)标准评价腰椎功能,依据改良Macnab标准比较2组患者的临床效果.结果 MIS-TLIF组患者的切口长度、术中失血量、术后引流量及住院时间均显著小于PLIF组(P<0.05).PLIF组和MIS-TLIF组患者的术前腰椎JOA评分分别为7.9±1.9、8.0±1.6,术后1 a的腰椎JOA评分分别为24.0±2.7、24.2±2.5,2组患者的术前、术后1 a的腰椎JOA评分组间比较差异均无统计学意义(P>0.05);2组患者术后1 a的腰椎JOA评分与术前比较均显著增加(P<0.05).术后1 a,PLIF组患者改良Macnab等级评定优良率为87.50％(14/16);MIS-TLIF组患者改良Macnab等级评定优良率为84.62％(11/13);2组患者的优良率比较差异无统计学意义(χ2=1.380,P>0.05).MIS-TLIF组术后并发症发生率为7.7％(1/13),PLIF组术后并发症发生率为6.3％(1/16),2组患者的术后并发症发生率比较差异无统计学意义(χ2=0.020,P>0.05).MIS-TLIF组患者中Ⅰ级融合8例(61.54％),Ⅱ级融合5例(38.46％);PLIF组中Ⅰ级融合9例(56.25％),Ⅱ级融合7例(43.75％);2组患者Ⅰ、Ⅱ级融合构成比比较差异无统计学意义(χ2=0.080,P>0.05).结论 MIS-TLIF治疗复发性LIDP具有手术切口小、术中出血少、术后引流量少、住院时间短等优点,且临床效果与PLIF相当.%Objective To compare the clinical effect of minimally invasive surgery transforaminal lumbar interbody fu-sion(MIS-TLIF)and posterior lumbar interbody fusion(PLIF)in the treatment of recurrent lumbar intervertebral disc hernia-tion(LIDH). Methods Twenty-nine patients with recurrent LIDP were selected from May 2014 to May 2016 in Weifang Peo-ple's Hospital and the clinical data were analyzed retrospectively. Thirteen patients were given MIS-TLIF(MIS-TLIF group) and sixteen patients were given PLIF(PLIF)group. The operative incision length,intraoperative bleeding volume,postoperative drainage volume,hospitalization time and complications were compared between the two groups. The lumbar function was evalu-ated with the Japanese Orthopaedic Association(JOA)score standard,and the clinical effect was compared between the two groups according to the modified Macnab standard one year after treatment. Results The operativeincision length,intraopera-tive bleeding volume,postoperative drainage volumeand hospitalization time in MIS-TLIF group were significantly less than tho-sein PLIF group (P < 0. 05). The preoperative JOA score of lumbar function in PLIF group and MIS-TLIF group was 7. 9 ± 1. 9 and 8. 0 ± 1. 6 respectively,it was 24. 0 ± 2. 7 and 24. 2 ± 2. 5 respectively at one year after treatment,there was no significant-difference in the JOA score between the two groups before and one year after operation (P > 0. 05). The JOA score atone year after operation was significantly higher than that before operation in the two groups (P < 0. 05). According to the modified Macnab standard one year after treatment,the fineness rate of the patients in PLIF group was 87. 50％(14 / 16),the fineness rate of the patients in the MIS-TLIF group was 84. 62％(11 / 13). There was no significant difference in the fineness rate be-tweenthe two groups (χ2 = 1. 380,P > 0. 05). The incidence of postoperative complications in the MIS-TLIF group and PLIF group was 7. 7％(1/ 13)and 6. 3％ (1/ 16)respectively,there was no significant difference in the incidence of postoperative complications between the two groups (χ2 = 0. 020,P > 0. 05). There were 8 cases (61. 5％)with gradeⅠfusion and 5 cases (38. 5％)with gradeⅡfusion in MIS-TLIF group,there were 9(56. 3％)with gradeⅠfusion and 7(43. 8％)with gradeⅡfu-sion,there was no significant difference in the constituent ratio with gradeⅠandⅡfusion between the two groups (χ2 = 0. 080, P >0. 05). Conclusion MIS-TLIF in treatment of recurrent LIDH has the advantages of less incision,less intraoperative bleed-ing,less postoperative drainage and shorter hospitalization time;and the clinical effect of MIS-TLIF is similar to that of PLIF.