摘要
[目的]前瞻性对比研究微创手术与开放手术行单节段腰椎后路椎间融合术的临床疗效和影像学结果。[方法]2011年10月～2012年10月，采用腰椎后路椎间融合手术治疗65例单节段腰椎退行性疾病患者。术前根据计算机随机分配方法将患者分为微创手术（微创组，n=33）和开放手术（开放组，n=32）。两组一般资料比较差异均无统计学意义（P〉0．05），具有可比性。最低随访1年，记录两组的手术时间、术中及术后失血量、总输血量、术后腰背痛程度（VAS评分）、卧床时间、住院时间、术后并发症、术后临床和影像学结果，并进行比较分析。[结果]65例患者，4例失访，其中微创组失访1例，开放组失访3例，余61例均获随访，时间1—2年，末次随访时，微创组优良率为90．7％，开放组为89．6％，差异无统计学意义（P=1．000）；两组平均椎问高度分别为（10．16±1．37）mm和（10．45±1．30）mm；两组平均椎间高度丢失率差异无统计学意义（P=0．852）；微创组31例（96．9％）椎体问达骨性融合，两组融合率差异无统计学意义（P=1．000）。但是微创手术相比传统开放手术术中出血量较少[（432．8±294．8）ml]VS．（737．9±224．3）ml，P=0．000]、手术时间短[（148．8±24．2）min VS．（191．7±37．7）min，P=0．000]、术后引流量少量[（175．3±162．2）ml VS．（482．9±165．3）ml，P=0．000]、术后输血少[（0．2±0．6）U vs．（0．9±1．1）u，P=0．002]、卧床时间短[（1．2±0．6）d VS．（2．9±1．1）d，P=0．000]、住院时间短[（5．3±2．6）dvs．（10．8±2．5）d，P=0．000]、术后疼痛轻（2．1±1．4VS．3．8±1．8，P=0．000）。[结论]微创手术和开放手术入路行单节段腰椎后路椎间融合术治疗退行性腰椎疾病，具有相似的临床疗效和放射学结果，但微创手术出血量和输血量较少、术后疼痛较轻、术后恢复较快及住院天数较短。
[ Objective] To compare the clinical and radiographic effects of the minimally invasive approach with those of the open approach for one - level instrumented posterior lumbar interbody fusion. [ Methods] Between October 2011 and 2012, 65 consecutive patients undergoing one - level instrumented posterior lumbar interbody fusion were prospectively randomized to undergo the minimally invasive approach （minimal group, n = 33 ） or open approach （open group, n = 33 ） . The two treatment groups were comparable considering the general data. The minimum follow - up period was 1 year. Patient data, including the clinical and radiographic results, surgical time, estimated blood loss, need for transfusion, postoperative back pain （ visual analogue scale）, recovery time needed before ambulation, length of hospital stay, and complications, were recorded. [ Results ] Among the 65 patients, 4 patients were lost to follow - up, and the remaining 61 patients were analyzed. Good to excellent clinical outcomes were achieved in 29 （90. 7% ） patients in the minimal group and 26 （89. 6% ） patients in the open group. There were no significant differences between the 2 groups considering the clinical and radiographic results. The minimal group was found to have significantly lesser blood loss （432. 8 ± 294. 8 ml vs. 737. 9± 224. 3 ml, P = 0. 000 ）, shorter operative time （148.8±24.2 min vs. 191.7±37.7 min, P=0.000）, lower need for transfusion （0.2 ±0.6 U vs.0. 9 ± 1.1 U, P= 0. 002 ）, lesser postoperative back pain （ 2. 1 ± 1.4 vs. 3.8 ± 1.8, P = 0. 000 ）, shorter recovery time before ambulation （ 1.2 ±0. 6 d vs. 2. 9 ± 1.1 d, P =0. 000）, and shorter length of hospital stay （5.3 ±2. 6 d vs. 10. 8 ±2. 5 d, P =0. 000） . [ Conclusion ] Both the minimally invasive and traditional open approaches for one - level instrumented posterior lumbar interbody fusion can achieve good to excellent clinical outcomes and radiographic results; however, the minimally invasive approach hasseveral advantages, including lesser blood loss, shorter operative time, lower need for transfusion, lesser postoperative back pain, quicker recovery, and shorter hospital stay.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2014年第13期1158-1163,共6页
Orthopedic Journal of China
关键词
比较研究
微创技术
开放技术
后路腰椎融合
comparison, minimally invasive approach, open approach, posterior lumbar interbody fusion
