摘要
目的对比可扩张通道下经椎间孔入路腰椎椎间融合术(MIS-TLIF)与椎间盘镜(MED)下椎间植骨融合内固定结合经皮椎弓根钉棒固定手术治疗腰椎退变性疾病(LDD)的近远期疗效。方法回顾性分析2014年6月—2016年12月本院收治的95例LDD患者,按照手术方式不同,分为MIS-TLIF组与MED组,MIS-TLIF组行可扩张通道辅助经椎间孔入路腰椎椎间融合术,MED组行椎间盘镜下椎间植骨融合内固定结合经皮椎弓根钉棒固定术,比较两组手术一般情况、不同时间疼痛[视觉模拟评分(VAS)]及功能障碍[Oswestry功能障碍指数(ODI)]、末次随访骨融合情况,并观察两组手术并发症。结果 MIS-TLIF组手术时间及术中透视次数均显著低于MED组(P<0.05),两组术中出血量、术后引流量差异无统计学意义(P>0.05);两组术后3、6个月VAS评分、ODI评分均显著低于术前(P<0.05),但两组同时间点VAS评分、ODI评分比较差异无统计学意义(P>0.05);MIS-TLIF组末次随访时骨融合率92.59%,与MED组的92.68%比较,差异无统计学意义(P>0.05);两组术中及术后均未见明显并发症。结论可扩张通道下MIS-TLIF与MED下融合治疗LDD患者,对患者疼痛、功能障碍改善程度大体相仿,两组术后骨融合及并发症情况相当,但MIS-TLIF手术时间及术中透视次数要低于MED下融合手术。
Objective To compare the short-term and long-term efficacy of expandable channel minimally invasive surgery transforaminal lumbar interbody fusion（ MIS-TLIF） and microendoscopy discectomy（ MED） interbody graft fusion internal fixation combined with percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases（ LDD）. Methods 95 cases of patients with LDD admitted to our hospital from June 2014 to December 2016 were retrospectively analyzed and were divided into MIS-TLIF group and MED group according to different surgical methods. MIS-TLIF group was given expandable channel minimally invasive surgery transforaminal lumbar interbody fusion,and MED group was given microendoscopy discectomy interbody graft fusion internal fixation combined with percutaneous pedicle screw fixation. The general operation conditions and pain at different time [visual analogue scale（ VAS） ],dysfunction [Oswestry dysfunction index（ ODI） ]and the bone fusion at the last follow-up were compared between the two groups,and surgical complications were observed in the two groups. Results The operative time and intraoperative fluoroscopy frequency in MIS-TLIF group were significantly lower than those in MED group（P〈0. 05）,and there was no significant difference in intraoperative blood loss and postoperative drainage volume between the two groups（P〈0. 05）. The VAS score and ODI score at 3 months and 6 months after operation in the two groups were significantly lower than those before operation（P〈0. 05）,but there was no significant difference in VAS score and ODI score between the two groups in the same time points（P〈0. 05）. There was no significant difference between MISTLIF group and MED group in bone fusion rate at the last follow-up（ 92. 59% vs 92. 68%）（P〈0. 05）. There were no obvious complications during and after operation between the two groups. Conclusions expandable channel MIS-TLIF and MED fusion surgery for patients with LDD have similar improvement of pain and dysfunction,and similar postoperative bone fusion and complications,but MIS-TLIF has lower operative time and intraoperative fluoroscopy frequency than MED fusion surgery.
作者
李再学
谢文伟
王志坤
苏厂尧
冉雪莲
LI Zaixue;XIE Wenwei;WANG Zhikun;SU Changyao;RAN Xuelian(The Third Hospital of Dongguan,Dongguan 523320,China)
出处
《现代医院》
2018年第8期1198-1200,1203,共4页
Modern Hospitals
基金
东莞市科研一般项目(20131051010072)
关键词
腰椎退行性疾病
可扩张通道
经椎间孔入路腰椎椎间融合术
椎间盘镜
椎间植骨融合内固定
经皮椎弓根钉棒固定
Lumbar Degenerative Diseases
Expandable Channel
Minimally Invasive Surgery- Transforaminal LumbarInterbody Fusion
Mieroendoseopy Diseeetomy
Interbody Graft Fusion Internal Fixation
Pereutaneous Pediele Screw Fixation
