【作者】 王江峰；

【导师】 臧虎；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 【目的】比较微创经椎间孔入路腰椎椎间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)与传统后路腰椎椎间融合术(posteriorlumbar interbody fusion,PLIF)治疗退变性两节段腰椎管狭窄症的临床疗效。【方法】回顾性分析2018年1月至2020年12月于吉林大学中日联谊医院脊柱外科确诊为两节段退变性腰椎管狭窄症并行手术治疗的患者42例。根据手术方式分为两组:MIS-TLIF手术组共21例,其中男性患者13(61.9)例,女性患者8(38.1)例,年龄63.6±7.6岁,L3-L5节段16(76.2)例,L4-S1节段5(23.8)例。PLIF手术组共21例,其中男性患者10(47.6)例,女性患者11(52.4)例,年龄61.7±6.0岁,L3-L5节段12(57.1)例,L4-S1节段9(42.9)例。记录年龄、性别、BMI、责任节段、吸烟、饮酒、滑脱分度,手术时间,术中失血量、切口长度、术后引流量、卧床时间、住院时间等。两组患者随访至少6个月。记录术前及术后3天、1月、3月、6月的腰腿痛VAS(Visual Analogue Score)评分和术前及术后1月、3月、6月的腰椎JOA评分(Japanese Orthopaedic Association Scores)进行比较分析,使用统计软件SPSS26.0对收集的数据进行统计学分析。【结果】1、患者的一般资料和入院病情特征资料构成方面均衡可比,构成比没有统计学差异。2、MIS-TLIF组患者的手术时间为(194.29±65.48)min,PLIF组为(156.05±32.81)min;MIS-TLIF组患者的切口长度为(7.03±0.40)cm,PLIF组为(13.80±3.50)cm;MIS-TLIF组患者的术中出血量为(260.00±58.22)ml,PLIF组为(370±106.58)ml;MIS-TLIF组术后引流量(155.48±80.61),PLIF组术后引流量(559.05±320.86);MIS-TLIF组患者卧床时间3.0(3.0 3.0)d,PLIF组为5.0(4.05.5)d;MIS-TLIF组患者的住院时间为8.0(7.0 10.5)d,PLIF组为14.0(10.5 16.5)d;MIS-TLIF组术后并发症发生率0(0.00),PLIF组术后并发症发生率1(4.80);MISTLIF组术后输血率2(9.50),PLIF组术后输血率3(14.3)。以上资料中两组间比较,手术时间方面PLIF组较短于MIS-TLIF组(P<0.05),术后并发症及术后输血率MIS-TLIF组与PLIF组两组间差异无统计学意义(P<0.05),其余均是MISTLIF组效果更佳,均有统计学差异(P<0.05)。3.两组内手术前与术后3天、1月、3月、6月VAS评分对比差异有统计学意义(P<0.05),两组间术后3天VAS评分,MIS-TLIF组略低于PLIF组(P<0.05),术后1月、3月、6月MIS-TLIF组与PLIF组两组间差异无统计学意义(P>0.05),说明术后短期内,MIS-TLIF手术对患者疼痛症状的缓解优于PLIF手术。两组内手术前与术后1月、3月、6月JOA评分对比差异有统计学意义(P<0.05),两组间术后1月、3月JOA评分,MIS-TLIF组略高于PLIF组(P<0.05),术后6月MIS-TLIF组与PLIF组两组间JOA评分差异无统计学意义(P>0.05),说明术后短期内,MIS-TLIF手术对患者疼痛症状的缓解优于PLIF手术。【结论】PLIF与MIS-TLIF都能有效治疗退变性两节段的腰椎椎管狭窄症,达到治愈的目的。在术中出血量、手术切口、术后引流量、术后卧床时间、术后住院时间等方面;及在术后早期腰部疼痛及功能恢复方面,MIS-TLIF手术具有优势,在手术时间方面,MIS-TLIF手术时间相对PLIF较长,因此,对于两节段的退变性腰椎椎管狭窄症患者,MIS-TLIF可以作为一种有效术式供术者选择。更多还原

【Abstract】 【Objective】To compare the clinical efficacy of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)with conventional posteriorlumbar interbody fusion(PLIF)for the treatment of degenerative two-segment lumbar spinal stenosis.fusion(PLIF)for the treatment of degenerative two-segment lumbar spinal stenosis.【Methods】Forty-two patients diagnosed with two-segment degenerative lumbar spinal stenosis and treated surgically in parallel at the Department of Spine Surgery,China-Japan Union Hospital of Jilin University from January 2018 to December 2020 were retrospectively analyzed.The patients were divided into two groups according to the surgical modality: 21 patients in the MIS-TLIF group,including 13(61.9)male patients and 8(38.1)female patients,aged 63.6±7.6 years,16(76.2)L3-L5 segments and 5(23.8)L4-S1 segments.21 patients in the PLIF group,including 10(47.6)male patients and 11(52.4)female patients.Female patients were 11(52.4),age 61.7±6.0years,12(57.1)in L3-L5 segment and 9(42.9)in L4-S1 segment.Age,gender,BMI,responsible segment,smoking,alcohol consumption,slippage score,operation time,intraoperative blood loss,incision length,postoperative drainage,bed rest time,and hospital stay were recorded.Patients in both groups were followed up for at least 6months.The preoperative and postoperative VAS(Visual Analogue Score)scores of low back pain at 3 days,January,March,and June and the preoperative and postoperative JOA scores(Japanese Orthopaedic Association Scores)of the lumbar spine at January,March,and June were recorded for comparative analysis,and the statistical software SPSS26.0 was used to analyze the data collected.The collected data were statistically analyzed using the statistical software SPSS26.0.【Results】1.The patients’ general data and admission characteristics data were balanced and comparable in terms of composition,and the composition ratios were not statistically different.2.The operative time of patients in the MIS-TLIF group was(194.29 ± 65.48)min,and that of the PLIF group was(156.05 ± 32.81)min;the incision length of patients in the MIS-TLIF group was(7.03 ± 0.40)cm in the MIS-TLIF group and(13.80±3.50)cm in the PLIF group;intraoperative bleeding in patients in the MISTLIF group was(260.00±58.22)ml and(370±106.58)ml in the PLIF group;postoperative drainage in the MIS-TLIF group(155.48±80.61)and in the PLIF group(559.05± 320.86);bed rest time for patients in the MIS-TLIF group was 3.0(3.0 3.0)d,and 5.0(4.0 5.5)d in the PLIF group;hospital stay for patients in the MIS-TLIF group was 8.0(7.0 10.5)d,and 14.0(10.5 16.5)d in the PLIF group;postoperative complication rate was 0(0.00)in the MIS-TLIF group and 1(4.80)in the PLIF group;the postoperative transfusion rate 2(9.50)in the MIS-TLIF group and 3(14.3)in the PLIF group.In the comparison between the two groups in the above data,the operative time was shorter in the PLIF group than in the MIS-TLIF group(P < 0.05),and the postoperative complications and postoperative transfusion rates were not statistically significant between the MIS-TLIF and PLIF groups(P < 0.05),but the rest were better in the MIS-TLIF group,and all of them were statistically different(P < 0.05).3.Within the two groups,the operative The difference between VAS scores before and 3 days after surgery,January,March and June was statistically significant(P < 0.05),and the VAS scores at 3 days after surgery between the two groups were slightly lower in the MIS-TLIF group than in the PLIF group(P < 0.05),and the difference between the MIS-TLIF group and the PLIF group at 1 month,March and June after surgery was not statistically significant(P > 0.05),indicating that in the short term after surgery The MIS-TLIF surgery was better than PLIF surgery in relieving patients’ pain symptoms.The differences in JOA scores between the two groups were statistically significant(P< 0.05)before and after surgery in January,March and June,and the differences in JOA scores between the two groups were slightly higher in the MIS-TLIF group than in the PLIF group in January and March(P < 0.05).In the short term after surgery,the MISTLIF procedure was better than the PLIF procedure in relieving patients’ pain symptoms.【Conclusion】Both PLIF and MIS-TLIF can effectively treat degenerative twosegment lumbar spinal stenosis and achieve a cure.In terms of intraoperative bleeding,surgical incision,postoperative drainage,postoperative bed rest,and postoperative hospital stay;and in terms of early postoperative lumbar pain and functional recovery,MIS-TLIF surgery has advantages,and in terms of operative time,MIS-TLIF surgery time is longer compared to PLIF,therefore,for patients with degenerative two-segment lumbar spinal stenosis,MIS-TLIF can Therefore,MIS-TLIF can be an effective procedure for patients with two-segment degenerative lumbar spinal stenosis.更多还原