经一侧入路双侧减压固定融合术与Open-TLIF治疗腰椎管狭窄症的疗效比较  

Unilateral laminectomy for bilateral decompression combined with minimally invasive lumbar interbody fusion versus Open-TLIF in treatment of lumbar spinal stenosis

作　　者：刘金龙[1] 刘彦宾 张志 王成虎[1] 李宗欢 张洪磊[1] LIU Jin-long;LIU Yan-bin;ZHANG Zhi;WANG Cheng-hu;LI Zong-huan;ZHANG Hong-lei(Department of Spinal Surgery,People's hospital of Liaocheng,Liaocheng,Shandong 252000,China)

机构地区：[1]聊城市人民医院脊柱外科,山东252000

出　　处：《中国骨与关节损伤杂志》2021年第11期1141-1144,共4页Chinese Journal of Bone and Joint Injury

基　　金：山东省自然科学基金(ZR2020MH100)。

摘　　要：目的比较经一侧入路双侧减压固定融合术与开放经椎间孔腰椎椎间融合术(Open-transforaminal lumbar interbody fusion,Open-TLIF)治疗腰椎管狭窄症的临床疗效。方法回顾性分析自2017-06—2019-06诊治的46例腰椎管狭窄症,20例采用经一侧入路双侧减压固定融合术治疗(微创组),26例采用Open-TLIF治疗(开放组)。比较2组手术时间、术中出血量、术中透视时间、住院时间以及末次随访时腰痛VAS评分、腿痛VAS评分、ODI指数、临床疗效、椎间融合情况。结果 2组均顺利完成手术并获得完整随访,随访时间13~26个月,平均18.9个月。微创组术中出血量、住院时间较开放组少,但术中透视时间多于开放组,差异有统计学意义(P<0.05),2组手术时间比较差异无统计学意义(P>0.05)。末次随访时2组腿痛VAS评分、ODI指数、临床疗效、椎间融合情况比较差异无统计学意义(P>0.05),腰痛VAS评分微创组小于开放组,差异有统计学意义(P<0.05)。结论经一侧入路双侧减压固定融合术与Open-TLIF治疗腰椎管狭窄症可取得相当的临床疗效,但前者组织损伤较小,术中出血量较少,可减少住院时间,是一种安全、有效的微创术式。Objective sion combined with minimally invasive lumbar interbody fusion and Open-transforaminal lumbar interbody fusion(Open-TLIF)in the treatment of lumbar spinal stenosis.Methods Forty-six patients with lumbar spinal stenosis treated from June 2017 to June 2019 were retrospectively analyzed. Twenty cases were treated with unilateral laminectomy for bilateral decompression combine with minimally invasive lumbar interbody fusion(minimally invasive group) and 26 cases were treated with Open-TLIF(Open-TLIF group). The operation time, blood loss, flouoroscopy time, length of hospital stay and VAS scores of back pain, ODI score, clinical efficacy and interbody fusion grade at last follow-up were compared between the two groups.Results groups successfully completed the operation and obtained a complete follow-up. The follow-up time was 13 to 26 months, with an average of 18.9 months. The blood loss and the length of hospital stay in the minimally invasive group were significantly less than those in the Open-TLIF group(P<0.05). The intraoperative flouoroscopy time in the minimally invasive group was more than that of Open-TLIF group(P<0.05). There were no significant difference regarding to operation time between the two group(P>0.05). Although there were no statistical difference in the VAS score of leg pain, ODI score, clinical efficacy and interbody fusion grade between the two group(P>0.05), the minimally invasive group had significantly lower back pain VAS score at the time of last follow-up postoperatively(P<0.05).Conclusion For the treatment of lumbar spinal stenosis, unilateral laminectomy for bilateral decompression combine with minimally invasive lumbar interbody fusion can achieve similar result in short term with Open-TLIF. The former has advantages of less blood loss, less trauma and shorter hospital stay. It is a safe, effective, minimally invasive surgery.

关 键 词：腰椎管狭窄症 微创手术 经一侧入路双侧减压 经椎板关节突螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]