摘要
[目的]比较微创经椎间孔椎间融合术(MIS-TLIF)和常规TLIF治疗L4/5单节段腰椎管狭窄症(LSS)的临床效果。[方法]回顾分析2016年1月~2018年1月本院采用TLIF手术收治的L4/5单节段LSS患者128例。其中,52例患者接受MIS-TLIF术,72例接受常规TLIF术。比较组间围手术期、随访和影像资料。[结果]MIS-TLIF组的手术时间长于常规TLIF组,但在切口长度、术中出血量、术后24 h引流量及住院时间均显著优于常规TLIF组(P<0.05)。随时间推移,两组VAS和ODI评分均显著降低(P<0.05),术后3个月MIS-TLIF组的VAS和ODI评分显著优于常规TLIF组(P<0.05)。影像方面,术后12个月,两组LL、FSA均较术前显著增加(P<0.05),但两组间差异无统计学意义(P>0.05)。末次随访时,ASD发生率MIS-TLIF组为9.62%,常规TLIF组为28.95%,差异有统计学意义(P<0.05);FJV发生率MIS-TLIF组为9.62%,常规TLIF组28.95%,差异有统计学意义(P<0.05)。[结论]MIS-TLIF治疗L4/5单节段LSS临床效果与常规TLIF相当,但减少了ASD和FJV的风险。
[Objective]To compare the clinical outcomes of minimally invasive versus conventional transforaminal lumbar interbody fusion(TLIF)for L4/5single-segment lumbar spinal stenosis(LSS).[Methods]A retrospective study was conducted on128 patients who underwent TLIF for L4/5single-segment LSS in our hospital from January 2016 to January 2018.Of them,52patients received MIS-TLIF,while the remaining 76 patients had conventional TLIF.The documents regarding to perioperation follow-up and radiographs were compared between the two groups.[Results]Although the MIS-TLIF group consumed significantly longer operation time than the conventional TLIF(P<0.05),the former proved significantly superior to the latter in incision length,intraoperative blood loss and drainage volume at 24 hours after the operation,and hospital stay(P<0.05).The VAS and ODI scores significantly decreased over time in both groups(P<0.05),and the MIS-TLIF group was significantly superior to the conventional TLIF in the two scores at 3 months postoperatively(P<0.05).With regard to radiographic assessment,the lumbar lordosis and fused segment angle significantly increased in both groups at 12 months after operation compared with those before operation(P<0.05),but which were not statistically significant between the two groups at any matching time point(P>0.05).At the latest follow up,the occurrence of adjacent segment degeneration(ASD)was of 9.62%in the MIS-TLIF group whereas 28.95%in the conventional TLIF group with a statistical significance(P<0.05).In addition,the superior-level facet joint violation(FJV)proved of 13.46%in the MIS-PLIF group,whereas 36.84%in the conventional TLIF group with a statistical significance(P<0.05).[Conclusion]The MIS-TLIF does achieve similar clinical outcomes to the conventional TLIF for L4/5single-segment LSS,additionally with advantages of reducing risk of ASD and FJV.
作者
马远
程省
郭雄飞
宋博
王挺
李显博
叶向阳
MA Yuan;CHENG Sheng;GUO Xiong-fei;SONG Bo;WANG Ting;LI Xian-bo;YE Xiang-yang(Nanyang Central Hospital,Nanyang 473000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第19期1729-1733,共5页
Orthopedic Journal of China
基金
国家自然基金面上项目(编号:81473633)。
关键词
腰椎管狭窄症
经椎间孔椎间融合术
微创手术
相邻节段退变
lumbar spinal stenosis
transforaminal lumbar interbody fusion
minimally invasive surgery
adjacent segment degeneration
