| 李丁,江涛,王烨,等.单切口Wiltse入路微创经椎间孔椎间融合术与后路椎间融合术治疗复发性腰椎间盘突出症的对比研究.骨科,2022,13(2): 115-120. |
| 单切口Wiltse入路微创经椎间孔椎间融合术与后路椎间融合术治疗复发性腰椎间盘突出症的对比研究 |
| Comparison between MIS-TLIF with Single Incision Wiltse Approach and PLIF in Treatment of Recurrent Lumbar Disc Herniation |
| 投稿时间：2021-08-18 |
| DOI：10.3969/j.issn.1674-8573.2022.02.004 |
| 中文关键词: Wiltse入路 经椎间孔腰椎椎间融合术 腰椎翻修手术 |
| 英文关键词: Wiltse approach Transforaminal lumbar interbody fusion Lumbar revision surgery |
| 基金项目:无锡市卫健委精准项目（J202005） |
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| 中文摘要: |
| 目的 比较单切口Wiltse入路微创经椎间孔腰椎椎体间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）与腰椎后路椎间融合术（posterior lumbar interbody fusion，PLIF）治疗复发性腰椎间盘突出症的临床疗效。方法 回顾性分析2016年1月至2018年10月我科手术治疗的44例复发性腰椎间盘突出症病人的临床资料。采用PIPELINE通道下单切口Wiltse入路MIS-TLIF手术治疗的23例纳入MIS-TLIF组，采用PLIF手术治疗的21例纳入PLIF组。记录手术时间、术中出血量、住院时间、手术前后疼痛视觉模拟量表（visual analogue scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、肌酸激酶值、并发症及末次随访椎间融合情况。结果 44例均顺利完成手术并定期随访，MIS-TLIF组随访时间为（16.91±3.37）个月，PLIF组随访时间为（16.81±3.04）个月。MIS-TLIF组手术时间、术中出血量、术后第2天肌酸激酶值均低于PLIF组，差异有统计学意义（P＜0.05）。所有病例术后的VAS评分、ODI指数均明显低于术前，差异有统计学意义（P＜0.05）；MIS-TLIF组术后下床时VAS评分低于PLIF组，差异有统计学意义（P＜0.05）。MIS-TLIF组出现2例硬膜撕裂，2例一过性神经根损伤；PLIF组出现4例硬膜撕裂，2例一过性神经根损伤。末次随访时，按照Bridwell融合评价分级，MIS-TLIF组Ⅰ级9例，Ⅱ级11例，Ⅲ级3例；PLIF组Ⅰ级7例，Ⅱ级11例，Ⅲ级3例。结论 与PLIF相比，单切口Wiltse入路MIS-TLIF治疗复发性腰椎间盘突出症具有创伤小、恢复快、并发症少的优点，但在长期随访中，两者在疼痛、功能恢复及融合效率等方面基本一致。 |
| 英文摘要: |
| Objective To compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with single incision Wiltse approach and posterior lumbar interbody fusion (PLIF) in the treatment of recurrent lumbar disc herniation. Methods The clinical data of 44 patients with recurrent lumbar disc herniation in our hospital from January 2016 to October 2018 were retrospectively analyzed. A total of 23 cases were treated with single incision Wiltse approach MIS-TLIF with PIPELINE, and 21 cases were treated with PLIF. The operation time, intraopertive blood loss, hospital stay, visual analogue scale (VAS) before and after operation, Oswestry disability index (ODI), creatine kinase value, complications and the intervertebral fusion at the last follow-up were recorded. Results All 44 cases were followed up regularly. The follow-up time was (16.91±3.37) months in MIS-TLIF group and (16.81±3.04) months in PLIF group. The operation time, intraoperative blood loss and creatine kinase on the second day after operation in MIS-TLIF group were significantly reduced as compared with those in PLIF group (P＜0.05). The postoperative VAS score and ODI of all cases were significantly lower than those before operation (P＜0.05). The VAS score in MIS-TLIF group when the patients squatted down was significantly lower than in PLIF group (P＜0.05). In MIS-TLIF group, there were 2 cases of dural tear and 2 cases of transient nerve root injury. In PLIF group, there were 4 cases of dural tear and 2 cases of transient nerve root injury. At the last follow-up, according to the Bridwell fusion evaluation, there were 9 cases of grade Ⅰ, 11 cases of grade Ⅱ and 3 cases of grade Ⅲ in MIS-TLIF group, and there were 7 cases of grade Ⅰ, 11 cases of grade Ⅱ and 3 cases of grade Ⅲ in PLIF group. Conclusion Compared with PLIF, MIS-TLIF with single incision Wiltse approach has the advantages of less trauma and faster recovery in the perioperative period, but long-term follow-up shows that they are basically consistent in pain, functional recovery and fusion efficiency. |
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