微创经椎间孔入路与极外侧入路腰椎椎间融合术治疗短节段腰椎退行性疾病的近期疗效比较
|
摘要
目的比较微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)与极外侧入路腰椎椎间融合术(XLIF)治疗退行性腰椎滑脱合并腰椎椎管狭窄的近期疗效。方法回顾性分析2013年3月—2014年6月收治的75例腰椎退行性疾病且行微创手术治疗患者的临床资料,其中36例选择行MIS-TLIF,39例选择行XLIF。记录2组患者手术时间、术中出血量,分析随访2年期间患者下肢痛和腰痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、生活质量评价量表(SF-36)评分和患者对手术的满意度。结果 MIS-TLIF组和XLIF组中位手术时间分别为169 min和182 min,差异无统计学意义(P> 0.05);MIS-TLIF组术中出血量为(90±20)mL,XLIF组术中出血量为(50±10)mL,差异有统计学意义(P <0.05)。随访2年,所有患者下肢痛和腰痛VAS评分、ODI和SF-36评分均较术前明显改善,差异有统计学意义(P <0.05),但组间比较差异均无统计学意义(P> 0.05)。结论 MIS-TLIF与XLIF虽然减压机制不同,但随访2年的术后疗效无明显差异,2种微创方法均可有效治疗腰椎退行性疾病。
Objective To compare the short-term efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) and extreme lateral approach lumbar interbody fusion(XLIF) for degenerative spondylolisthesis with lumbar spinal stenosis. Methods From March 2013 to June 2014,clinical data of 75 patients with degenerative lumbar diseases treated by minimally invasive surgery were retrospectively analyzed. Thirty-six patients underwent MIS-TLIF and 39 underwent XLIF. The operation time and intraoperative blood loss were recorded,and the visual analogue scale(VAS) scores of low back and lower limb pain,Oswestry disability index(ODI),quality of life score(SF-36) and satisfaction during 2-year follow-up were analyzed. Results The median operation time of MIS-TLIF group and XLIF group was 169 min and 182 min respectively,with no significant difference(P > 0.05). The intraoperative blood loss in MIS-TLIF group was(90±20)mL,and that in XLIF group was(50±10)mL,with a significant difference(P < 0.05). During 2-year follow-up,all the patients were significantly improved than pre-operation in low back and lower limb pain VAS scores,ODI and quality-of-life(SF-36) score,all with significant differences(P < 0.05);and the differences between the 2 groups were not significant(P > 0.05). Conclusion Although the decompression mechanisms between MIS-TLIF and XLIF are different,there is no significant difference in the efficacy of 2-year follow-up,suggesting MIS-TLIF and XLIF can both be used as effective and minimally invasive treatment for lumbar degenerative diseases.
Objective To compare the short-term efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) and extreme lateral approach lumbar interbody fusion(XLIF) for degenerative spondylolisthesis with lumbar spinal stenosis. Methods From March 2013 to June 2014,clinical data of 75 patients with degenerative lumbar diseases treated by minimally invasive surgery were retrospectively analyzed. Thirty-six patients underwent MIS-TLIF and 39 underwent XLIF. The operation time and intraoperative blood loss were recorded,and the visual analogue scale(VAS) scores of low back and lower limb pain,Oswestry disability index(ODI),quality of life score(SF-36) and satisfaction during 2-year follow-up were analyzed. Results The median operation time of MIS-TLIF group and XLIF group was 169 min and 182 min respectively,with no significant difference(P > 0.05). The intraoperative blood loss in MIS-TLIF group was(90±20)mL,and that in XLIF group was(50±10)mL,with a significant difference(P < 0.05). During 2-year follow-up,all the patients were significantly improved than pre-operation in low back and lower limb pain VAS scores,ODI and quality-of-life(SF-36) score,all with significant differences(P < 0.05);and the differences between the 2 groups were not significant(P > 0.05). Conclusion Although the decompression mechanisms between MIS-TLIF and XLIF are different,there is no significant difference in the efficacy of 2-year follow-up,suggesting MIS-TLIF and XLIF can both be used as effective and minimally invasive treatment for lumbar degenerative diseases.
引文
[1]Villavicencio AT,Burneikiene S,Roeca CM,et al.Minimally invasive versus open transforaminal lumbar interbody fusion[J].Surg Neurol Int,2010,1:12.
[2]Ozgur BM,Aryan HE,Pimenta L,et al.Extreme lateral interbody fusion(XLIF):a novel surgical technique for anterior lumbar interbody fusion[J].Spine J,2006,6(4):435-443.
[3]Youssef JA,McAfee PC,Patty CA,et al.Minimally invasive surgery:lateral approach interbody fusion:results and review[J].Spine(Phila Pa 1976),2010,35(26 Suppl):S302-S311.
[4]McGirt MJ,Parker SL,Lerner J,et al.Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion:analysis of hospital billing and discharge data from 5170 patients[J].J Neurosurg Spine,2011,14(6):771-778.
[5]Parker SL,Mendenhall SK,Shau DN,et al.Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis:comparative effectiveness and cost-utility analysis[J].World Neurosurg,2014,82(1/2):230-238.
[6]Lucio JC,Vanconia RB,Deluzio KJ,et al.Economics of less invasive spinal surgery:an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period[J].Risk Manag Healthc Policy,2012,5:65-74.
[7]Rodgers WB,Gerber EJ,Rodgers JA.Lumbar fusion in octogenarians:the promise of minimally invasive surgery[J].Spine(Phila Pa 1976),2010,35(26 Suppl):S355-S360.
[8]Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[9]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273
[10]Ware JE Jr,Sherbourne CD.The MOS 36-item short-form health survey(SF-36).I.Conceptual framework and item selection[J].Med Care,1992,30(6):473-483.
[11]American Spinal Injury Association.Standards for neurological classification of spinal injury patients[M].Chicago:American Spinal Injury Association,1992.
[12]Goldstein CL,Macwan K,Sundararajan K,et al.Comparative outcomes of minimally invasive surgery for posterior lumbar fusion:a systematic review[J].Clin Orthop Relat Res,2014,472(6):1727-1737.
[13]Sun ZJ,Li WJ,Zhao Y,et al.Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:a metaanalysis[J].Chin Med J(Engl),2013,126(20):3962-3971.
[14]Parker SL,Adogwa O,Bydon A,et al.Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years[J].World Neurosurg,2012,78(1/2):178-184.
[15]Lehmen JA,Gerber EJ.MIS lateral spine surgery:a systematic literature review of complications,outcomes,and economics[J].Eur Spine J,2015,24(Suppl 3):287-313.
[16]Kim CW.Scientific basis of minimally invasive spine surgery:prevention of multifidus muscle injury during posterior lumbar surgery[J].Spine(Phila Pa 1976),2010,35(26 Suppl):S281-S286.
[17]Wang J,Zhou Y,Zhang ZF,et al.Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2[J].Eur Spine J,2010,19(10):1780-1784.
[18]张烽,段广超,金国华.下腰椎极外侧椎体间融合术的应用解剖[J].中国脊柱脊髓杂志,2007,17(11):859-861.
[19]胡万坤,贺石生,李明.极外侧入路腰椎椎间融合术[J].中国脊柱脊髓杂志,2009,19(8):634-635.
[20]郑扬,李危石,陈仲强,等.微创与开放经椎间孔椎体间融合术治疗腰椎单节段退行性疾病的临床疗效比较[J].中国脊柱脊髓杂志,2014,24(12):1064-1071.
[21]肖波,毛克亚,王岩,等.微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术并发症的比较分析[J].脊柱外科杂志,2013,11(1):23-27.
[22]Peng CW,Yue WM,Poh SY,et al.Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion[J].Spine(Phila Pa 1976),2009,34:1385-1389.
[23]Rodgers WB,Gerber EJ,Patterson J.Intraoperative and early postoperative complications in extreme lateral interbody fusion:an analysis of 600 cases[J].Spine(Phila Pa 1976),2011,36(1):26-32.
[24]刘希麟,席焱海,马俊,等.微创极外侧入路腰椎椎间融合术治疗退行性腰椎椎管狭窄症的初步应用和早期疗效分析[J].脊柱外科杂志,2015,13(4):198-202.
[25]Anand N,Rosemann R,Khalsa B,et al.Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis[J].Neurosurg Focus,2010,28(3):E6.
[26]Knight RQ,Schwaegler P,Hanscom D,et al.Direct lateral lumbar interbody fusion for degenerative conditions:early complication profile[J].J Spinal Disord Tech,2009,22(1):34-37.
[2]Ozgur BM,Aryan HE,Pimenta L,et al.Extreme lateral interbody fusion(XLIF):a novel surgical technique for anterior lumbar interbody fusion[J].Spine J,2006,6(4):435-443.
[3]Youssef JA,McAfee PC,Patty CA,et al.Minimally invasive surgery:lateral approach interbody fusion:results and review[J].Spine(Phila Pa 1976),2010,35(26 Suppl):S302-S311.
[4]McGirt MJ,Parker SL,Lerner J,et al.Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion:analysis of hospital billing and discharge data from 5170 patients[J].J Neurosurg Spine,2011,14(6):771-778.
[5]Parker SL,Mendenhall SK,Shau DN,et al.Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis:comparative effectiveness and cost-utility analysis[J].World Neurosurg,2014,82(1/2):230-238.
[6]Lucio JC,Vanconia RB,Deluzio KJ,et al.Economics of less invasive spinal surgery:an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period[J].Risk Manag Healthc Policy,2012,5:65-74.
[7]Rodgers WB,Gerber EJ,Rodgers JA.Lumbar fusion in octogenarians:the promise of minimally invasive surgery[J].Spine(Phila Pa 1976),2010,35(26 Suppl):S355-S360.
[8]Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[9]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273
[10]Ware JE Jr,Sherbourne CD.The MOS 36-item short-form health survey(SF-36).I.Conceptual framework and item selection[J].Med Care,1992,30(6):473-483.
[11]American Spinal Injury Association.Standards for neurological classification of spinal injury patients[M].Chicago:American Spinal Injury Association,1992.
[12]Goldstein CL,Macwan K,Sundararajan K,et al.Comparative outcomes of minimally invasive surgery for posterior lumbar fusion:a systematic review[J].Clin Orthop Relat Res,2014,472(6):1727-1737.
[13]Sun ZJ,Li WJ,Zhao Y,et al.Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease:a metaanalysis[J].Chin Med J(Engl),2013,126(20):3962-3971.
[14]Parker SL,Adogwa O,Bydon A,et al.Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years[J].World Neurosurg,2012,78(1/2):178-184.
[15]Lehmen JA,Gerber EJ.MIS lateral spine surgery:a systematic literature review of complications,outcomes,and economics[J].Eur Spine J,2015,24(Suppl 3):287-313.
[16]Kim CW.Scientific basis of minimally invasive spine surgery:prevention of multifidus muscle injury during posterior lumbar surgery[J].Spine(Phila Pa 1976),2010,35(26 Suppl):S281-S286.
[17]Wang J,Zhou Y,Zhang ZF,et al.Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2[J].Eur Spine J,2010,19(10):1780-1784.
[18]张烽,段广超,金国华.下腰椎极外侧椎体间融合术的应用解剖[J].中国脊柱脊髓杂志,2007,17(11):859-861.
[19]胡万坤,贺石生,李明.极外侧入路腰椎椎间融合术[J].中国脊柱脊髓杂志,2009,19(8):634-635.
[20]郑扬,李危石,陈仲强,等.微创与开放经椎间孔椎体间融合术治疗腰椎单节段退行性疾病的临床疗效比较[J].中国脊柱脊髓杂志,2014,24(12):1064-1071.
[21]肖波,毛克亚,王岩,等.微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术并发症的比较分析[J].脊柱外科杂志,2013,11(1):23-27.
[22]Peng CW,Yue WM,Poh SY,et al.Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion[J].Spine(Phila Pa 1976),2009,34:1385-1389.
[23]Rodgers WB,Gerber EJ,Patterson J.Intraoperative and early postoperative complications in extreme lateral interbody fusion:an analysis of 600 cases[J].Spine(Phila Pa 1976),2011,36(1):26-32.
[24]刘希麟,席焱海,马俊,等.微创极外侧入路腰椎椎间融合术治疗退行性腰椎椎管狭窄症的初步应用和早期疗效分析[J].脊柱外科杂志,2015,13(4):198-202.
[25]Anand N,Rosemann R,Khalsa B,et al.Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis[J].Neurosurg Focus,2010,28(3):E6.
[26]Knight RQ,Schwaegler P,Hanscom D,et al.Direct lateral lumbar interbody fusion for degenerative conditions:early complication profile[J].J Spinal Disord Tech,2009,22(1):34-37.