对比微创经椎间孔腰椎间融合术与开放经椎间孔腰椎间融合术治疗双节段退变性腰椎疾病。
Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease.
机构信息
Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China.
出版信息
Int Orthop. 2014 Apr;38(4):817-24. doi: 10.1007/s00264-013-2169-x. Epub 2013 Nov 17.
PURPOSE
The purpose of this study was to compare the clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease.
METHODS
We conducted a prospective cohort study of 82 patients, who underwent two-level minimally invasive or open transforaminal lumbar interbody fusion (TLIF) from March 2010 to December 2011. Forty-four patients underwent minimally invasive transforaminal lumbar interbody fusion (MITLIF) (group A) and 38 patients underwent the traditional open TLIF (group B). Demographic data and clinical characteristics were comparable between the two groups before surgery (p > 0.05). Peri-operative data, clinical and radiological outcomes between the two groups were compared.
RESULTS
The mean follow-up period was 20.6 ± 4.5 months for group A and 20.0 ± 3.3 months for group B (p > 0.05). No significant difference existed in operating time between the two group (p > 0.05). X-ray exposure time was significantly longer for MITLIF compared to open cases. Intra-operative blood loss and duration of postoperatively hospital stay of group A were significantly superior to those of group B (p < 0.05). On postoperative day three, MITLIF patients had significantly less pain compared to patients with the open procedure. No statistical difference existed in pre-operative and latest VAS value of back pain (VAS-BP) and leg pain (VAS-LP), pre-operative and latest ODI between the two groups. The fusion rate of the two groups was similar (p < 0.05). Complications included small dural tear, superficial wound infection and overlong screws. When comparing the total complications, no significant difference existed between the groups (p > 0.05).
CONCLUSIONS
MITLIF offers several potential advantages including postoperative back pain and leg pain, intra-operative blood loss, transfusion and duration of hospital stay postoperatively in treating two-level lumbar degenerative disease. However, it required much more radiation exposure.
目的
本研究旨在比较微创经椎间孔腰椎体间融合术（TLIF）与开放 TLIF 在治疗 2 节段退行性腰椎疾病中的临床和影像学结果。
方法
我们对 2010 年 3 月至 2011 年 12 月期间接受 2 节段微创或开放 TLIF 的 82 例患者进行了前瞻性队列研究。44 例患者接受微创经椎间孔腰椎体间融合术（MITLIF）（A 组），38 例患者接受传统开放 TLIF（B 组）。两组患者术前的人口统计学数据和临床特征相似（p＞0.05）。比较两组围手术期数据、临床和影像学结果。
结果
A 组的平均随访时间为 20.6±4.5 个月，B 组为 20.0±3.3 个月（p＞0.05）。两组手术时间无显著差异（p＞0.05）。与开放病例相比，MITLIF 的 X 射线暴露时间明显更长。A 组术中出血量和术后住院时间明显优于 B 组（p＜0.05）。术后第 3 天，MITLIF 患者的疼痛明显低于开放组。两组术前及末次腰痛视觉模拟评分（VAS-BP）、腿痛视觉模拟评分（VAS-LP）、术前及末次 Oswestry 功能障碍指数（ODI）无统计学差异。两组融合率相似（p＞0.05）。并发症包括小硬脊膜撕裂、浅表伤口感染和螺钉过长。两组总并发症发生率无显著差异（p＞0.05）。
结论
MITLIF 治疗 2 节段腰椎退行性疾病具有潜在优势，包括术后腰痛和腿痛减轻、术中出血量减少、术后输血和住院时间缩短。然而，它需要更多的辐射暴露。
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