MA-OTIF与MIS-TLIF治疗老年腰椎退行性病变的近期疗效的病例对照研究

目的:比较小切口开放经椎间孔腰椎椎体间融合术(MA-OTIF)与微创经椎间孔融合术(MIS-TLIF)治疗老年性腰椎退行性病变的近期疗效。方法:收集2010年1月-2013年1月我院收治的老年性腰椎退行性病变患者,根据治疗方式不同,选择行MA-OTIF治疗者作为研究组,行MIS-TLIF者作为对照组,按一定条件以1:1比例进行配对研究,比较两组患者的手术相关指标及术前和术后的视觉模拟评分(VAS)和功能障碍评分(ODI)。结果:本研究共纳入60例患者,均完成至少1年的随访,平均随访时间1.36年。与MIS-TLIF组比较,MA-OTIF组的手术时间明显缩短,X线透视次数显著减少、术中出血量明显增加,差异均有统计学意义(P0.05),但两组的住院时间比较均无明显统计学差异(P0.05)。两组术后VAS和ODI评分均较术前显著降低,差异具有统计学意义(P0.05),但两组术前与术后VAS和ODI评分比较均无显著性差异(P0.05)。随访期间,两组均未发生神经根损伤、手术部位感染和椎弓根螺钉断裂等不良情况。结论:MA-OTIF与MIS-TLIF治疗老年性腰椎退行性病变近期疗效相似,MA-OTIF兼备OTLIF和MIS-TLIF的优势。

Comparative Study on Application of MA-OTIF and MIS-TLIF in the Treatment of Recent Curative Effect of Senile Lumbar Degenerative Disease Cases

Objective:To compare the short-term curative effect ofmini open transforaminal lumbar interbody fusion (MA-OTIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of senile lumbar degenerative disease.Methods:Elderly patients with spinal degenerative diseases admitted in our hospital from January 201 0 to January 2013 admitted were selected. According to the different treatment methods, the patients treated by MA-OTIF were selected as research group, while the patients treated by MIS-TLIF were selected as control group. The operative index, preoperative and postoperative visual analogue scale (VAS) and dysfunction score (ODI) scores were compared between two groups.Results:60 patients completed at least 1 year of follow-up, the mean follow-up period was 1.36 years. Compared with MIS-TLIF group, the MA-OTIF group had significantly shorter operation time, lower times of X-ray and more intreoperative bleeding(P<0.05), but no significant difference was found in the hospital stay between two groups (P>0.05). The postoperative VAS and ODI scores of both groups were significantly decreased than those before operation (P<0.05), but no significant difference was observed in the preoperative and postoperative VAS and ODI score between two groups (P>0.05). During the follow-up visit, no nerve root injury, operation site infection and breakage of pedicle screws and other adverse conditions was observed in both groups.Conclusion:The recent therapeutic effect of MA-OTIF in the treatment of senile lumbar degeneration was equal to MIS-TLIF, MA-OTIF had the advantages of both MIS-TLIF and OTLIF.