两种椎体间融合术治疗双节段腰椎管狭窄的比较  

Comparison of two kinds of lumbar interbody fusion for double-segment lumbar spinal stenosis

作　　者：蒋小红 王辉[1] 郑亚东 唐海军 方旭[1] 陆生林[1] JIANG Xiao-hong;WANG Hui;ZHENG Ya-dong;TANG Hai-jun;FANG Xu;LU Sheng-lin(Minzu Hospital,Guangxi Medical University,Nanning 530000,China)

机构地区：[1]广西医科大学附属民族医院,广西南宁530000

出　　处：《中国矫形外科杂志》2021年第21期1934-1938,共5页Orthopedic Journal of China

基　　金：广西卫生和计划委员会自筹经费科研课题项目(编号:Z20170289);广西自然科学基金项目(编号:2018GXNSFBA281119)。

摘　　要：[目的]比较Quadrant通道下经椎间孔入路腰椎间融合术(minimally invasive surgery-transforaminal lumbar interbody fusion,MIS-TLIF)与开放性后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗双节段腰椎管狭窄症的疗效。[方法]本院2016年1月—2019年1月手术治疗的双节段腰椎管狭窄症患者60例,依据术前医患沟通结果将患者分为两组。其中,24例采用MIS-TLIF,其余36例采用PLIF。比较两组围手术期、随访和影像资料。[结果]MIS-TLIF组的手术时间显著长于PLIF组(P<0.05),MIS-TLIF组切口长度、术中出血量、术后引流量、下地行走时间和住院时间均显著优于PLIF组(P<0.05)。MIS-TLIF组下地时间和完全负重活动时间均显著早于PLIF组(P<0.05)。随时间推移,两组患者腰痛和腿痛VAS评分,以及ODI评分均显著下降(P<0.05)。术后6个月,MIS-TLIF组的腰痛和腿痛VAS评分均显著优于PLIF组(P<0.05),但两组间ODI评分的差异无统计学意义(P<0.05);末次随访时,两组间腰痛和腿痛VAS评分,以及ODI评分的差异均无统计学意义(P>0.05)。影像学方面,末次随访时MIS-TLIF组椎管面积显著大于PLIF组(P<0.05)。[结论]MIS-TLIF治疗双节段椎管狭窄的临床效果显著优于PLIF。[Objective]To compare the clinical outcomes of minimally invasive surgery-transforaminal lumbar interbody fusion(MISTLIF)under the Quadrant channel versus the open posterior lumbar interbody fusion(PLIF)for double-segment lumbar spinal stenosis.[Methods]A total of 60 patients were surgically treated for double-segment lumbar spinal stenosis in our hospital from January 2016 to January 2019,and were divided into two groups based on the results of preoperative doctor-patient communication.Among them,24 pa⁃tients underwent MIS-TLIF,while the remaining 36 patients received PLIF.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]Although the MIS-TLIF group consumed significantly longer operation time than the PLIF group(P<0.05),the former proved significantly superior to the latter in terms of incision length,intraoperative blood loss,postoperative drainage,time to resume walking and hospital stay(P<0.05).The MIS-TLIF group resumed full-weight bearing activity significantly earli⁃er than the PLIF group(P<0.05).The VAS scores of low back pain and leg pain,as well as ODI scores decreased significantly in both groups over time(P<0.05).At 6 months after operation,the MIS-TLIF group were significantly better than the PLIF group in terms of the VAS scores of low back pain and leg pain(P<0.05),but the difference in ODI score between the two groups was not statistically significant(P<0.05).At the last follow-up there was no a significant difference in any aforesaid scores between the two groups(P>0.05).With respect of imaging assessment,the area of the involved spinal canal in the MIS-TLIF group was significantly larger than that in the PLIF group at the latest follow-up(P<0.05).[Conclusion]The MIS-TLIF is considerably better than the PLIF in clinical outcomes for double-segment spinal stenosis.

关 键 词：两节段腰椎管狭窄症 Quadran 通道 微创经椎间孔入路腰椎间融合术 后路腰椎间融合术 

分 类 号：R687[医药卫生—骨科学]