两种微创腰椎融合内固定术治疗腰椎间盘突出症的围术期比较

Comparison of perioperative characteristics between two methods of minimally invasive transforaminal lumber interbody fusion in treatment of lumbar disc herniation

  • 摘要: 目的 比较S-Tube下微创经椎间孔腰椎体间融合术(minimally invasive transforminal lumber interbody fusion,MISTLIF),用双侧椎弓根螺钉内固定和单侧椎弓根螺钉结合经椎板关节突螺钉混合内固定两种术式围术期指标的差异。 方法 回顾性分析2009年1月-2013年12月于我院采用S-Tube下MIS-TLIF手术治疗单节段腰椎间盘突出症的患者159例,其中69例行单侧混合内固定(A组),90例行双侧椎弓根螺钉内固定(B组),比较手术时间、出血量、输血量、术后下地时间、术后住院时间、总住院时间、手术前后腰痛腿痛视觉模拟评分(visual analogue scale,VAS)及并发症情况。 结果 两组一般资料差异无统计学意义(P> 0.05)。A组手术时间(111±13) min,术中出血量(85±46) ml;B组手术时间(123±12) min,术中出血量(110±52) ml;A组手术时间与术中出血量均小于B组,差异有统计学意义(P< 0.01)。两组间术后下地时间、住院时间、手术前后腰腿疼痛VAS评分及并发症发生率无统计学差异(P> 0.05)。 结论 单侧切口MIS-TLIF使用单侧椎弓根螺钉结合经椎板关节突螺钉混合内固定较双侧椎弓根螺钉内固定创伤小、出血量少、手术时间短。

     

    Abstract: Objective To investigate the difference of perioperative characteristics between unilateral incision hybrid fixation using pedicle screws and translaminar screw and bilateral pedicle fixation in minimally invasive transforminal lumber interbody fusion (MIS-TLIF). Methods A retrospective analysis was conducted on 159 patients with single-level lumber disc herniation undergoing MIS-TLIF in Chinese PLA General Hospital from January 2009 to December 2013. Patients were divided into two groups:69 cases underwent hybrid fixation using pedicle screws and translaminar screw (group A); 90 cases underwent bilateral pedicle fixation (group B). The perioperative characteristics, including operative time, blood loss, transfusion, ambulation time, hospitalization time after surgery, total hospitalization time, postoperative low back and leg pain visual analogue scale (VAS) score and its complication, were compared between the two groups. Results There was no significant difference in the common clinical data between the two groups (P> 0.05). The average blood loss and operative time in group A were significantly less than group Bblood loss:(85±46) ml vs. (110±52) ml; operative time:(111±13) min vs. (123±12) min, P< 0.01. No significant difference was found in ambulation time, hospitalization time, postoperative low back and leg pain VAS score and complication rate between two groups (P> 0.05). Conclusion Hybrid fixation by pedicle and translaminar screw in MIS-TLIF has less invasion and operation time than bilateral pedicle fixation.

     

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