MIS-TLIF与开放TLIF手术治疗单节段腰椎退行性疾病的比较
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摘要
目的比较微创经椎间孔椎体间融合术(MIS-TLIF)与开放TLIF手术治疗单节段腰椎退行性疾病的临床治疗效果。方法回顾性分析自2013-07—2017-10诊治的115例腰椎退行性疾病,其中MIS-TLIF组60例,开放TLIF组55例。比较2组手术时间、术中出血量、术中透视时间、术后引流量、下床时间、住院时间,术后1周、1个月、6个月疼痛VAS评分及ODI指数,以及末次随访时MacNab评分。结果 115例均获得随访,随访时间平均12.6(6～16)个月。随访期间均未发现融合器移位、下沉,无椎弓根钉松动、断裂,椎间植骨融合良好。与开放TLIF组比较,MIS-TLIF组术中出血量、术后引流量明显较少,下床时间更早,术后1周、术后1个月疼痛VAS评分与ODI指数更低,但手术时间、透视时间明显更长,差异有统计学意义(P <0.05)。末次随访时2组MacNab评分差异无统计学意义(P>0.05)。结论 MIS-TLIF手术治疗单节段腰椎退行性疾病可取得与开放TLIF手术相同的疗效,MIS-TLIF手术创伤更小,患者下床时间更早,疼痛缓解更快,但其手术难度更大、技术要求更高。
引文
[1]何祥乐,李传将,王小勇. Quadrant通道下MIS-TLIF治疗腰椎退行性疾病的疗效分析[J].中国骨与关节损伤杂志,2018,33(1):24-27.
[2] Phan K,Rao PJ,Kam AC,et al. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:systematic review and meta-analysis[J]. Eur Spine J,2015,24(5):1017-1030.
[3]魏家森,赵阳,朱振军,等.改良TLIF与传统PLIF治疗腰椎中央管狭窄伴单侧神经根管狭窄的比较[J].中国骨与关节损伤杂志,2018,33(3):286-287.
[4] Aihara T,Toyone T,Murata Y,et al. Degenerative lumbar spondylolisthesis with spinal stenosis:a comparative study of 5-year outcomes following decompression with fusion and microendoscopic decompression[J]. Asian Spine J,2018,12(1):132-139.
[5]陈志刚,吕书军,李立东,等. Quadrant通道下经肌间隙入路TLIF治疗单节段腰椎退行性疾病[J].实用骨科杂志,2016,22(2):155-158.
[6]刘永征,陈国平,朱文虎,等.腰椎间盘突出症经Wiltse入路TLIF术后并发症原因分析及预防策略[J].中国骨与关节损伤杂志,2018,33(3):288-289.
[7] Parker SL,Lerner J,McGirt MJ. Effect of minimally invasive technique on return to work and narcotic use following transforaminal lumbar inter-body fusion:a review[J]. Prof Case Manag,2012,17(5):229-235.
[8] Kurzbuch AR,Recoules-Arche D. Minimal invasive lumbar spine revision surgery at distance from the dura and postsurgical scar tissue:extraforaminal lumbar interbody fusion(ELIF)[J]. J Clin Neurosci,2018,47:332-336.
[9] Lee KH,Yeo W,Soeharno H,et al. Learning curve of a complex surgical technique:minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)[J]. J Spinal Disord Tech,2014,27(7):E234-240.
[2] Phan K,Rao PJ,Kam AC,et al. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:systematic review and meta-analysis[J]. Eur Spine J,2015,24(5):1017-1030.
[3]魏家森,赵阳,朱振军,等.改良TLIF与传统PLIF治疗腰椎中央管狭窄伴单侧神经根管狭窄的比较[J].中国骨与关节损伤杂志,2018,33(3):286-287.
[4] Aihara T,Toyone T,Murata Y,et al. Degenerative lumbar spondylolisthesis with spinal stenosis:a comparative study of 5-year outcomes following decompression with fusion and microendoscopic decompression[J]. Asian Spine J,2018,12(1):132-139.
[5]陈志刚,吕书军,李立东,等. Quadrant通道下经肌间隙入路TLIF治疗单节段腰椎退行性疾病[J].实用骨科杂志,2016,22(2):155-158.
[6]刘永征,陈国平,朱文虎,等.腰椎间盘突出症经Wiltse入路TLIF术后并发症原因分析及预防策略[J].中国骨与关节损伤杂志,2018,33(3):288-289.
[7] Parker SL,Lerner J,McGirt MJ. Effect of minimally invasive technique on return to work and narcotic use following transforaminal lumbar inter-body fusion:a review[J]. Prof Case Manag,2012,17(5):229-235.
[8] Kurzbuch AR,Recoules-Arche D. Minimal invasive lumbar spine revision surgery at distance from the dura and postsurgical scar tissue:extraforaminal lumbar interbody fusion(ELIF)[J]. J Clin Neurosci,2018,47:332-336.
[9] Lee KH,Yeo W,Soeharno H,et al. Learning curve of a complex surgical technique:minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)[J]. J Spinal Disord Tech,2014,27(7):E234-240.