微创与开放TLIF治疗复发性腰椎间盘突出症的疗效比较

Comparative study of treating recurrent lumbar disc herniation by MIS-TLIF and Open TLIF

关键词:  腰椎间盘突出症  复发  椎间融合  疗效

Key words:  lumbar disc herniation  recurrent  interbody fusion  outcome

摘要:

目的　比较分析微创经椎间孔腰椎融合术(MIS-TLIF)与开放经椎间孔腰椎融合术 (TLIF)治疗复发性腰椎间盘突出症的临床效果。方法　回顾性分析2014年5月至2016年5月收治的28例复发性腰椎间盘突出症患者的临床资料,13例行微创TLIF（MIS-TLIF组）,15例行开放TLIF（TLIF组）。比较两组患者手术切口长度、手术时间、术中失血量、术后引流量、平均住院日及并发症情况。术后1年采用日本骨科协会评分(JOA)评测腰椎功能，依据改良Macnab标准比较两组临床效果。结果　微创TLIF组手术切口长度、术中失血量、术后引流量、平均住院日优于开放TLIF组，差异有统计学意义(P<0.05)，手术时间开放TLIF组少于微创TLIF组，差异有统计学意义(P<0.05)，并发症发生率两组比较无差异。两组JOA评分术后1年均较术前明显提高，差异有统计学意义(P<0.05)，术前及术后JOA评分两组间比较差异无统计学意义(P>0.05)。根据Macnab标准，微创TLIF组和开放TLIF组的疗效优良率分别为84.6%和86.7%,两组之间比较差异无统计学意义(P>0.05)。结论　微创TLIF具有手术切口小、术中出血少、住院时间短的优点，治疗复发性腰椎间突出症与开放TLIF效果相当，值得临床推广应用。

Abstract:

Objective To examine the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open transforaminal lumbar interbody fusion (TLIF) for treatment of recurrent lumbar disc herniation. Methods From May 2014 to May 2016, we collected 28 patients with recurrent lumbar disc herniation and randomly divided into two groups, including MIS-TLIF group (n=13) and Open TLIF group (n=15). The incision length, operative duration, blood loss, postoperative drainage volume, average length of stay and postoperative complications were observed. Japanese Orthopedic Association Scale (JOA) was used for lumbar function one year post-surgery. The results of surgery were also evaluated with the modified Macnab classification. Results Mean incision length, blood loss, postoperative drainage volume and average length of stay was significantly better in the MIS-TLIF group as compared to the TLIF group (P<0.05). Operative duration was significantly longer in the MIS-TLIF group than that in the open group (P<0.05). Both groups had significantly improved JOA score one year after surgery (P<0.05). The preoperative and postoperative JOA scores showed no statistically significant difference between the MIS-TLIF and TLIF groups (P>0.05); no significant difference in the complications rate was found. According to the modified Macnab classification, the excellent and good rates were 84.6 % (MIS-TLIF) and 86.7 %(TLIF), there was no significant difference between the two groups (P>0.05). Conclusion For recurrent lumbar disc herniation, MIS-TLIF has more advantages over open TLIF in terms of less incision length, reduced blood loss, shorter hospital stay, promise a reliable clinical outcome, and is worth to be spread.