微创与开放TLIF治疗腰椎间盘突出伴功能性侧弯△

Minimally invasive TLIF versus open counterpart for single- segment lumbar disc herniation with functional scoliosis

摘要:

［目的］ 评估内镜辅助经椎间孔腰椎融合术 （minimaly invasive surgery-transforaminal lumbar interbody fusion, MISTLIF）治疗伴功能性脊柱侧弯的单节段腰椎间盘突出症的疗效。［方法］回顾性分析 2014 年 6 月—2020 年 12 月接受手术的 51 例伴有功能性脊柱侧弯的单节段腰椎间盘突出症患者的临床资料，依据医患沟通结果，20 例采用 MIS-TLIF （微创组），31 例采用开放 TLIF （开放组）。比较两组临床和影像资料。［结果］ 两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。微创组术中出血量、切口长度、住院时间显著优于开放组（P<0.05）。随访（19.55±4.28）个月，随时间推移，两组腰腿痛 VAS、ODI 评分均显著降低 （P<0.05），但相应时间点，两组间上述评分的差异无统计学意义 （P>0.05）。影像方面，两组末次随访时侧弯 Cobb 角较术前均显著显著减小 （P<0.05），而椎间隙高度及与 L₁~S₁前凸角显著增加 （P<0.05）。［结论］ 与开放 TLIF 相比，内镜辅助 TLIF 具有手术切口小、术中出血量少、术后住院时间短的优势。

Abstract:

[Objective] To evaluate the clinical efficacy of endoscope-assisted transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar disc herniation with functional scoliosis. [Methods] A retrospective study was conducted on 51 patients who underwent surgical treatment for single-level lumbar disc herniation with functional scoliosis from June 2014 to December 2020. According to doctorpatient communication, 20 patients received MIS- TLIF (the MIS group) , while the other 31 patients underwent open TLIF (the open group) . The clinical and imaging data of the two groups were compared. [Results] All patients in both groups had operation completed suc- cessfully without serious complications. The MIS group proved significantly superior to the open group in terms of intraoperative bleeding, incision length and hospital stay (P＜0.05) . As time went during the follow-up lasted for (19.55±4.28) months, the VAS scores for lumbar and leg pain, as well as ODI score in both groups significantly decreased (P＜0.05) , whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05) . Radiographically, the scoliotic Cobb angle significantly decreased (P＜0.05) , while the height of intervertebral space and L₁~S₁ lordotic angle significantly increased in both groups at the latest follow-up compared with those preoperatively (P＜0.05) . [Conclusion] This endoscope-assisted TLIF has advantages of smaller surgical incision, less intraoperative bleeding, and shorter hospital stay over the open TLIF for single-level lumbar disc herniation with functional scoliosis.