微创经椎间孔椎间融合术治疗退变性腰椎滑脱症的近期疗效评价

摘要

Objective To compare the clinical efficacy of MIS-TLIF technique and traditional open TLIF in the treatment of degenerative lumbar spondylolisthesis,thus to explore the MIS-TLIF technique advantage in clinical application.Methods From February 2014 to October 2014,30patients with DLS suffered the MIS-TLIF were enrolled as the observation group.30 patients with DLS suffered traditional open TLIF were enrolled as the control group.Preoperative and postoperative serum creatine kinase level,incision length,operative time,intraoperative blood loss,postoperative flow and incision complications were recorded.Preoperative and postoperative VAS and ODI scores were recorded.The slippage correction by measuring the slip angle and the slip rate of preoperation and postoperation were assessed.To evaluate intervertebral fusion with X-ray and CT results after 18months and clinical efficacy with MacNab criteria.Results There was no statistically significant difference in preoperative serum creatine kinase level between two groups (P＞0.05).Postoperative serum creatine kinase level significantly increased in two groups,and that of the control group was higher than the observation group,the difference was statistically significant (P＜0.05).The incision length,intraoperative blood loss and postoperative flow of the observation group were lower than those of the control group,and the differences were statistically significant (P＜0.05).In two groups,postoperative VAS and ODI scores were lower than preoperation,and the differences were statistically significant(P＜0.05).Postoperative 3 days,1 month,3 months,VAS and ODI scores of the observation group were lower than the control group,and the differences were statistically significant (P＜0.05),but at the rest of the postoperative phases,there was no statistically significant difference (P＞0.05).In two groups,postoperative slip angle and the slip rate were lower than preoperation,and the differences were statistically significant (P＜0.05).According to MacNab criteria,the satisfactory rate of the observation group was 93.33％,and the satisfactory rate of the control group was 90.00％.4 cases in 30 cases of the control group occurred incision exudation,and the incisions of the 4 cases obtained delayed union by means of pressure bandaging,reinforced seams and antibiotics.But there was no incision complication occurred in the observation group.Conclusion MIS-TLIF technique in the treatment of mild degenerative lumbar spondylolisthesis is better than the open TLIF,but it will take surgeon long time to learn.%目的 通过回顾性分析,探讨微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)在退变性腰椎滑脱症治疗中的优势.方法 选取2014-02-2014-10月我科收住60例退变性腰椎滑脱患者,其中观察组(行MIS-TLIF术)30例,对照组(传统开放TLIF术)30例.记录两组术前及术后1d血清肌酸激酶含量、切口长度、手术时间、术中出血量、术后引流量及切口并发症情况;记录术前及术后各时相(3d、1个月、3个月、6个月、1年)VAS评分及ODI评分;测量并计算术前及末次随访滑脱角、滑脱率来评估滑脱矫正情况;根据术后18个月X线及CT结果评价椎间融合情况,根据MacNab标准评定优良率.结果 术后两组血清肌酸激酶水平均明显升高,且对照组(开放TLIF组)高于观察组(MIS-TLIF),差异有统计学意义(P＜0.05);观察组手术切口长度、术中出血量及术后引流量均少于对照组(P＜0.05);两组术后各时相评分均高于术前(P＜0.05);术后3天、1个月、3个月VAS、ODI评分相比,观察组均显著低于对照组(P＜0.05);而术后6个月、1年评分两组无明显差异(P＞0.05);各组术后末次随访滑脱角及滑脱率均小于术前(P＜0.05);根据MacNab标准,观察组优22例、良6例、可2例,优良率为93.33％;对照组优19例、良8例、可3例,优良率为90.00％;观察组30例患者无一例发生切口渗出、感染、延迟愈合;对照组30例患者中4例出现切口渗出,但未发生切口感染,经加压包扎、缝线加固、抗生素等处理,均获得延迟愈合.结论 微创TLIF在轻度退变性腰椎滑脱的治疗中优于开放TLIF,但需术者经过较长时间的学习.