经皮椎间孔腰椎体间融合术与微创前路腰椎体间融合术联合斜向自锚式单臂椎间融合器治疗腰椎间盘突出症的回顾性研究：2 年随访结果
Transforaminal Lumbar Interbody Fusion Versus Mini-open Anterior Lumbar Interbody Fusion With Oblique Self-anchored Stand-alone Cages for the Treatment of Lumbar Disc Herniation: A Retrospective Study With 2-year Follow-up.
机构信息
The Second Xiangya Hospital of Central South University, Hunan, China.
出版信息
Spine (Phila Pa 1976). 2017 Nov 1;42(21):E1259-E1265. doi: 10.1097/BRS.0000000000002145.
STUDY DESIGN
A retrospective study.
OBJECTIVE
The aim of this study was to evaluate the clinical and radiological outcomes of mini-open ALIF (MO-ALIF) with self-anchored stand-alone cages for the treatment of lumbar disc herniation in comparison with transforaminal lumbar interbody fusion (TLIF).
SUMMARY OF BACKGROUND DATA
Currently, whether ALIF is superior to TLIF for the treatment of lumbar disc herniation remains controversial.
METHODS
This study retrospectively reviewed 82 patients who underwent MO-ALIF with self-anchored standalone cages (n = 42) or TLIF (n = 40) for the treatment of lumbar disc herniation between April 2013 and October 2014. Patient demographics, intraoperative parameters, and perioperative complications were collated. Clinical outcomes were evaluated using the visual analog scale (VAS) scoring, the Oswestry Disability Index (ODI) for pain in the leg and back, and radiological outcomes, including fusion, lumbar lordosis (LL), disc height (DH), and cage subsidence were evaluated at each follow-up for up to 2 years.
RESULTS
Patients who underwent TLIF had a significantly higher volume of blood loss (295.2 ± 81.4 vs. 57.0 ± 15.2 mL) and longer surgery time (130.7 ± 45.1 vs. 60.4 ± 20.8 min) than those who had MO-ALIF. Compared with baseline, both groups had significant improvements in the VAS and ODI scores and DH and LL postoperatively, though no significant difference was found between the two groups regarding these indexes. All patients reached solid fusion at the final follow-up in both groups. Three patients (3/42) with three levels (3/50) suffered from cage subsidence in the MO-ALIF group; meanwhile, no cage subsidence occurred in the TLIF group.
CONCLUSION
MO-ALIF with self-anchored stand-alone cages is a safe and effective treatment of lumbar disc herniation with less surgical trauma and similar clinical and radiological outcomes compared with TLIF.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
本研究旨在评估微创前路腰椎间融合术（MO-ALIF）联合自固式独立 cage 治疗腰椎间盘突出症的临床和影像学结果，并与经椎间孔腰椎间融合术（TLIF）进行比较。
背景资料概要
目前，ALIF 是否优于 TLIF 治疗腰椎间盘突出症仍存在争议。
方法
本研究回顾性分析了 2013 年 4 月至 2014 年 10 月期间接受 MO-ALIF 联合自固式独立 cage（n=42）或 TLIF（n=40）治疗腰椎间盘突出症的 82 例患者。收集患者的人口统计学资料、术中参数和围手术期并发症。采用视觉模拟评分（VAS）、下肢和背部疼痛 Oswestry 功能障碍指数（ODI）评估临床结果，并在随访期间评估影像学结果，包括融合、腰椎前凸角（LL）、椎间盘高度（DH）和 cage 下沉，随访时间最长 2 年。
结果
TLIF 组的出血量（295.2±81.4 vs. 57.0±15.2 mL）和手术时间（130.7±45.1 vs. 60.4±20.8 min）明显高于 MO-ALIF 组。与基线相比，两组患者的 VAS 和 ODI 评分以及 DH 和 LL 均有显著改善，但两组间这些指标无显著差异。两组患者在最终随访时均达到了牢固的融合。MO-ALIF 组有 3 例（3/42）、3 个节段（3/50）发生 cage 下沉；而 TLIF 组无 cage 下沉。
结论
MO-ALIF 联合自固式独立 cage 治疗腰椎间盘突出症是一种安全有效的方法，与 TLIF 相比，手术创伤较小，临床和影像学结果相似。
证据等级
3 级。
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