腰椎微创与开放椎间融合的影像学特征及疗效比较

目的 评价腰椎微创与开放手术椎间融合器植入空间位置的影像学特征以及两种手术方法的临床疗效对比。方法 回顾性分析2013年1月至2015年2月同济大学附属同济医院腰椎微创(n=38)或开放椎间融合术(n=55)的93例临床资料。通过双相空间标识点识别技术测量两种手术术后X线片中融合器的空间位置,对比两种手术方式中椎间融合器植入空间位置的差异及临床疗效。结果 所有患者均顺利完成手术,微创组患者的术中出血量及住院天数明显低于开放组(P<0.05)。两组患者术后VAS、ODI较术前比较差异有统计学意义(P<0.05),但组间对比差异无统计学意义(P>0.05)。椎间融合器空间位置MIS组明显优于Open组,差异有统计学意义(P<0.05)。结论 微创与开放椎间融合均是治疗腰椎退变性疾病的有效手术方式,微创组具有恢复快、出血少的优势,而且微创手术较开放手术植入的融合器更容易获得靠前、靠中央的理想位置。
ObjectiveTo compare efficacy and radiological features of spatial position of interbody fusion cage between minimally invasive transforaminal lumber interbody fusion (MIS-TLIF) and open surgery (Open-TLIF). Methods The clinical data of 93 patients with lumbar degenerative disease of single segment, who received MIS-TLIF (38 cases) or Open-TLIF surgery (55 cases) in Tongji Hospital Tongji University, from January 2013 to February 2015, were retrospectively analyzed. The spatial position of the interbody fusion cage was measured in postoperative X-ray films with double phase image recognition technology for space target sequences. The clinical efficacy and the spatial location of interbody fusion cage were compared between two surgical methods. Results All operations were successful. The intraoperative blood loss was less and the length of hospital stay was shorter in MIS-TLIF group compared to those in TLIF group (P<0.05). The VAS and ODI score had significantly improved during the follow up (P<0.05) in both groups and no significant differences were found between two groups at the same time point (P>0.05). As for spatial position of spatial position of the fusion device, the placement of MIS-TLIF group was superior to that of Open-TLIF group, and there was significant difference (P>0.05). Conclusion MIS-TLIF and Open-TLIF are effective surgical methods for treatment of lumbar degenerative disease. Compared with Open-TLIF, MIS-TLIF has the advantages of faster recovery and less intraoperative blood loss; moreover the interbody fusion cage in minimally invasive surgery is easier to receive an anterior and middle position than that in open surgery