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后路腰椎间融合术(PLIF)与改良经椎间孔腰椎间融合术(M-TLIF)治疗单节段腰椎退变性疾病的安全性和疗效比较。

Comparison of safety and efficacy of posterior lumbar interbody fusion (PLIF) and modified transforaminal lumbar interbody fusion (M-TLIF) in the treatment of single-segment lumbar degenerative diseases.

机构信息

Guangzhou University of Traditional Chinese Medicine, Guangdong, China.

Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16, Airport Road, Baiyun District, Guangzhou, 510000, China.

出版信息

J Orthop Surg Res. 2024 Jan 30;19(1):95. doi: 10.1186/s13018-024-04531-3.

Abstract

OBJECTIVE

To compare modified transforaminal lumbar interbody fusion (M-TLIF) with posterior lumbar interbody fusion (PLIF) in the treatment of single-segment lumbar degenerative disorders in order to assess its safety and effectiveness.

METHODS

From January 2016 to January 2021, 74 patients who received single-segment M-TLIF were examined. A total of 74 patients having single-segment PLIF during the same time period were included in a retrospective controlled study using the same inclusion and exclusion criteria. The two groups were compared in terms of the fusion rate, the Oswestry disability index (ODI), the visual analogue scale of low back pain (VAS), the perioperative condition, the postoperative complications, and the postoperative neighbouring segment degeneration.

RESULTS

All patients had surgery satisfactorily and were monitored for at least a year afterwards. The baseline values for the two groups did not significantly differ. The interbody fusion rate between PLIF (98.65%) and M-TLIF (97.30%) was not significantly different. In the follow-up, the M-TLIF group's VAS score for low back and leg pain was lower than that of the PLIF group. The ODI score of the M-TLIF group was lower than that of the PLIF group at 7 days and 3 months following surgery. Both groups' post-op VAS and ODI scores for low back and leg pain were much lower than those from before the procedure. In M-TLIF group, the operation time, drainage tube extraction time, postoperative bed rest time and hospital stay time were shorter, and the amount of intraoperative blood loss was less. Compared with those before operation, the height of intervertebral space and intervertebral foramen were significantly increased in both groups during postoperative follow-up (P < 0.05). The postoperative complications and adjacent segment degeneration of M-TLIF were significantly lower than those of PLIF.

CONCLUSIONS

M-TLIF is a safe and effective treatment for lumbar degenerative disorders, with a high fusion rate and no significant difference between M-TLIF and PLIF. M-TLIF's efficacy and safety are comparable to that of PLIF, particularly in terms of early relief of low back pain and improvement in quality of life following surgery. Therefore, M-TLIF technology can be popularized and applied in clinic.

摘要

目的

比较改良经椎间孔腰椎体间融合术(M-TLIF)与后路腰椎体间融合术(PLIF)治疗单节段腰椎退行性疾病,以评估其安全性和有效性。

方法

2016 年 1 月至 2021 年 1 月,共检查了 74 例接受单节段 M-TLIF 的患者。使用相同的纳入和排除标准,对同期行单节段 PLIF 的 74 例患者进行回顾性对照研究。比较两组融合率、Oswestry 功能障碍指数(ODI)、腰痛视觉模拟评分(VAS)、围手术期情况、术后并发症和术后邻近节段退变。

结果

所有患者均顺利完成手术,并在术后至少随访 1 年。两组的基线值无显著差异。PLIF(98.65%)和 M-TLIF(97.30%)的椎间融合率无显著差异。在随访中,M-TLIF 组的腰痛和腿痛 VAS 评分低于 PLIF 组。与 PLIF 组相比,M-TLIF 组术后 7 天和 3 个月的 ODI 评分较低。两组术后腰痛和腿痛的 VAS 和 ODI 评分均较术前明显降低。在 M-TLIF 组,手术时间、引流管拔出时间、术后卧床时间和住院时间较短,术中出血量较少。与术前相比,两组术后随访时椎间间隙和椎间孔高度均显著增加(P<0.05)。M-TLIF 的术后并发症和邻近节段退变明显低于 PLIF。

结论

M-TLIF 治疗腰椎退行性疾病安全有效,融合率高,与 M-TLIF 无显著差异。M-TLIF 的疗效和安全性与 PLIF 相当,特别是在术后腰痛缓解和生活质量改善方面。因此,M-TLIF 技术可以在临床上推广应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97ef/10826027/c74b3fcecbbd/13018_2024_4531_Fig1_HTML.jpg

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