摘要目的 探讨显微镜辅助下经椎间孔椎间融合微创手术( MIS-TLIF)治疗腰椎退变性疾病的临床疗效及安全性.方法 回顾性分析2016年1月—2017年1月空军军医大学西京医院骨科160名腰椎退变性疾病患者的临床资料,其中80 例行开放经椎间孔椎间融合术( TLIF)为对照组, 80例行显微镜辅助下 MIS-TLIF 为观察组.对比两组患者手术前后腿痛视觉模拟评分( VAS)、Oswestry功能障碍指数(ODI)、手术时间、手术切口长度、术中出血量、术后引流量、X线照射时间、术后椎间植骨融合率以及并发症情况等.结果 观察组和对照组患者手术切口长度分别为 (3. 7 ± 0. 8) cm和(8. 2 ± 1. 5) cm ,手术出血量分别为 (63. 2 ± 30. 3) mL和(170. 6 ± 21. 4) mL,术后引流量分别为 (22. 1 ± 10. 7) mL和(80. 2 ± 20. 3) mL,X线照射时间分别为 (26. 1 ± 3. 7) s和(16. 5 ± 4. 2) s,差异均有统计学意义 (t=23. 680、25. 902、22. 651、15. 343, P值均<0. 01) .观察组和对照组患者术后1 年VAS分别为(0. 68 ± 0. 41)分和(1. 95 ± 0. 64)分,ODI分别为7. 29% ± 3. 60%和12. 70% ± 4. 27% ,差异均有统计学意义 (t=14. 950、8. 664,P值均<0. 01).观察组的神经根损伤、硬膜囊撕裂、马尾神经损伤等并发症发生率分别为 1. 25% ( 1/80 )、 0、 0,低于对照组的13.75%(11/80)、10.00(8/80)、11.25%(9/80),差异均有统计学意义(χ2=7.297、6.447、7.535, P值均<0. 05);而椎间植骨融合率100. 00% (80/80)则高于对照组的83. 75% (67/80),差异有统计学意义(χ2=12. 057, P<0. 01).结论 显微镜辅助下MIS-TLIF微创手术治疗腰椎退变性疾病疗效好、安全性高,手术创伤小、术后恢复快,建议临床推广应用.

abstractsObjective To assess the clinical effects and safety of microscope assisted minimal invasive surgery-transforaminal lumbar inter-body fusion(MIS-TLIF) in the treatment of lumbar degenerative disease. Methods From January 2016 to January 2017, 160 patients of lumbar degenerative disease were retrospectively analyzed. Eighty patients underwent TLIF ( the control group) and 80 patients underwent microscope assisted MIS-TLIF ( the observation group). Clinical evaluation: visual analog scale ( VAS), Oswestry disability index (ODI), blood loss, postoperative drainage, X-irradiate time, length of hospital stay and interbody fusion rate. Results The surgical incision length was (3. 7 ± 0. 8) cm in the observation group and (8. 2 ± 1. 5) cm in the control group. The blood loss was (63. 2 ± 30. 3) mL in observation group and (170. 6 ± 21. 4) mL in control group. The postoperative drainage flow was (22. 1 ± 10. 7) mL in observation group and (80. 2 ± 20. 3) mL in the control group. The X-ray exposure time was (26. 1 ± 3. 7)s in observation group and(16. 5 ± 4. 2)s in control group, There were all significant differences between the two groups(t=23. 680, 25. 902, 22. 651, 15. 343, all P values<0. 01). The VAS scores (0. 68 ± 0. 41 vs. 1. 95 ± 0. 64, t=14. 950, P<0. 01) and the ODI (7. 29% ± 3. 60% vs. 12. 70% ± 4. 27% , t=8. 664, P<0. 01) showed significant differences between the observation group and the control group at one year of follow-up. The incidence of complications in the observation group was lower than that in the control group(P<0. 05). The rate of intervertebral bone graft fusion in the observation group was higher than that in the control group(P <0. 01). Conclusions MIS-TLIF assisted by microscope is a safe and effective treatment for lumbar degenerative disease. Patients with this operation have less traumas and recover faster after operation. Microscope assisted TLIF is worthy of clinical promotion.