微创经椎间孔入路椎体间融合术治疗退行性腰椎管狭窄症的中远期疗效分析  

Analysis of mid-and long-term curative effect of minimally invasive transforaminal lumbar interbody fusion in the treatment of double segmental lumbar spinal stenosis

作　　者：谭章勇 汪建良[1] 许科峰 肖俊 孙子杰[1] Tan Zhangyong;Wang Jianliang;Xu Kefeng;Xiao Jun;Sun Zijie(Department of Orthopedics,Joint Logistic Support Force 904 Hospital,Jiangsu Wuxi 213000,China)

机构地区：[1]中国人民解放军联勤保障部队第904医院骨科,江苏无锡213000

出　　处：《中国医刊》2022年第6期647-650,共4页Chinese Journal of Medicine

基　　金：无锡市卫生计生委课题(MS201722)。

摘　　要：目的探讨微创经椎间孔入路椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗单节段退行性腰椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)的中远期疗效。方法回顾性分析2017年12月至2021年3月中国人民解放军联勤保障部队第904医院骨科收治的60例单节段DLSS患者,根据治疗方法的不同分为观察组(32例)和对照组(28例)。观察组患者采用MIS-TLIF治疗,对照组患者采用开放TLIF治疗。比较两组患者的手术时间、术中出血量、术后引流量和住院时间,术前和术后12个月随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)、腰椎功能日本骨科学会(Japanese Orthopaedic Association,JOA)评分情况及影像学指标(Cobb角、椎间孔高度和椎间孔面积),以及两组的并发症发生情况。结果两组手术时间比较差异无显著性(P>0.05),观察组的术中出血量、术后引流量和住院时间明显低于对照组,差异有显著性(P<0.05)。术前两组患者的VAS评分、ODI、JOA评分比较差异无显著性(P>0.05);术后12个月随访时,两组患者的VAS评分、ODI、JOA评分均明显优于术前,且观察组明显优于对照组,差异有显著性(P<0.05)。术前两组患者的Cobb角、椎间孔高度和椎间孔面积比较差异无显著性(P>0.05);术后两组Cobb角、椎间孔高度和椎间孔面积均明显高于术前,差异有显著性(P<0.05),而术后两组间比较差异无显著性(P>0.05)。观察组术后并发症发生率(6.25%)明显低于对照组(17.86%),差异有显著性(P<0.05)。结论MIS-TLIF治疗单节段DLSS具有良好的中远期疗效,且术后并发症发生率较低,值得临床应用。Objective To evaluate the safety and efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and TLIF in patients with double level degenerative lumbar spinal stenosis(DLSS).Method Sixty patients with double segment DLSS admitted to our hospital from December 2017 to March 2021 were retrospectively analyzed.28 patients in the open group received open TLIF treatment,and 32 patients in the minimally invasive group received MIS-TLIF treatment.The observation indexes included perioperative index,follow-up index and imaging index.Result The intraoperative blood loss and hospital stay in the minimally invasive group were significantly better than those in the open group(P<0.05).At the last follow-up,the straight leg elevation angle,pain VAS score,JOA score and ODI index of the two groups were significantly improved(P<0.05),and the improvement degree of the minimally invasive group was better than that of the open group(P>0.05);the incidence of adverse reactions in the minimally invasive group was significantly lower than that in the open group(P<0.05).There was little difference in imaging indexes between the two groups(P>0.05).Conclusion MIS-TLIF in the treatment of double segment DLSS patients can obtain good long-term curative effect,effectively avoid the impact of surgical trauma on rehabilitation,and reduce the incidence of adverse events.

关 键 词：退行性腰椎管狭窄症 微创经椎间孔入路椎体间融合术 治疗效果 

分 类 号：R681.5[医药卫生—骨科学]