Quadrant通道下MIS-TLIF与传统术式治疗单节段腰椎退变性疾病的疗效比较

目的:对比分析Quadrant通道下微创椎间孔椎间融合术(MIS-TLIF)与传统开放经椎间孔椎间融合术(TLIF)治疗单节段腰椎退变性疾病的临床疗效和安全性。方法:选取2012年3月至2015年3月120例我院收治的120例单节段腰椎退变性疾病患者,并将其随机分为对照组和微创(MIS)组,每组各60例。对照组患者给予TLIF治疗,微创组给予MIS-TLIF治疗。观察和比较两组患者的手术情况,手术前后的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),肌酸磷酸激酶(CPK)水平、椎间植骨融合率及并发症的发生情况。结果:微创组患者的切口长度、出血量、射线照射时间、下地活动时间以及住院时间均显著低于或短于对照组(P0.05);术后1周、6个月,微创组患者的VAS、ODI评分均显著低于对照组(P0.05);术后,两组患者的CPK水平出现剧烈上升,随后又逐渐下降,但同一时段微创组患者的CPK水平明显低于对照组(P0.05);微创组的椎骨性融合率为93.33%(56/60),显著低于对照组(85.00%,P0.05),且其神经损伤、硬膜囊破裂的发生率均显著低于对照组(P0.05),感染的发生率比较差异无统计学意义(P0.05)。结论:Quadrant通道下微创椎间孔椎间融合术治疗单节段腰椎退变性疾病的临床疗效明显优于传统开放经椎间孔椎间融合术,且创伤更小,患者康复更快,安全性更高。

A Comparative Study on the Clinical Effect of MIS-TLIF under Quadrant Channel and Traditional Operation on the Patients with Single Segment Lumbar Degenerative Disease

ABSTRACT Objective: To compare the curative effect and safety of minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) under Quadrant channel and traditional open surgery transforaminal lumbar interbody fusion (TLIF) for patients with single segment lumbar degenerative disease. Methods: 120 patients with single segment lumbar degenerative disease were collected and randomly divided into two groups. The control group (n=60) was treated by TLIF, and minimally invasive surgery (MIS) group (n=60) was treated by MIS-TLIF, the operative condition was compared between two groups, the VAS and ODI scores in the period of operation were evaluated, the creatine phosphokinase (CPK), interbody fusion rate and incidence of complicates were compared between two groups. Results: The incision length, bleeding, time of irradiation and ground activity and hospital stay of MIS group were significantly shorter or lower than those in the control group (P<0.05). A1 week and 6 month after operation, the VAS and ODI scores of MIS group were lower than those in the control group(P<0.05). After operation, the CPK level of all patients was remarkably increased, and then gradually descended. However, the CPK level of MIS group was significantly lower than thoseof the control group at the same time (P<0.05). The interbody fusion rate of MIS group was 93.33% (56/60), which was significantly higher than that of the control group (85.00%, P<0.05), the incidence of nerve injury, dural sac rupture of MIS group was significantly lower than that of the control group(P<0.05), no significant difference was found in the incidence of infection between two groups(P>0.05). Conclusion: The clinical curative effect of minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) under Quadrant channel for patients with single segment lumbar degenerative disease was superior to traditional open surgery, which possessed less trauma, faster recovery and higher safety.