2023 年第 9 期 第 18 卷

经椎间孔腰椎椎体间融合术和后路腰椎椎体间融合术治疗单节段退变性腰椎管狭窄症的有效性和安全性分析

Efficacy and safety of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion on treatment of monosegment degenerative lumbar spinal stenosis

作者：刘华林龙泉郑耿阳曹杰林顺新黄钿锋

英文作者：Liu Hua Lin Longquan Zheng Gengyang Cao Jie Lin Shunxin Huang Dianfeng

单位：中国人民解放军联勤保障部队第九一〇医院骨科，泉州362000

英文单位：Department of Orthopedics the 910th Hospital of Joint Logistic Support Force of the Chinese People′s Liberation Army Quanzhou 362000 China

关键词：腰椎管狭窄症；经椎间孔腰椎椎体间融合术；后路腰椎椎体间融合术

英文关键词：Lumbarspinalstenosis；Transforaminallumbarinterbodyfusion；Posteriorlumbarinterbodyfusion

• 摘要：

• 目的  探讨经椎间孔腰椎椎体间融合术（TLIF）和后路腰椎椎体间融合术（PLIF）对单节段退变性腰椎管狭窄症的有效性和安全性。方法 选取2016年3月至2021年3月中国人民解放军联勤保障部队第九一〇医院收治的112例单节段退变性腰椎管狭窄症患者，根据手术方式不同分为TLIF组（55例）和PLIF组（57例）。比较2组手术时间、术中出血量、术后引流量、疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）、椎间隙高度、腰椎前凸角、椎间融合率和并发症发生率。结果 TLIF组手术时间短于PLIF组［(132±30)min比（215±43）min，t=11.812，P＜0.001］、术中出血量及术后引流量少于PLIF组［(284±48)ml比（386±65）ml、（310±62）ml比（344±52）ml］，差异均有统计学意义（t=9.410、11.239，均P＜0.001）。 2组术后1周和术后6个月VAS评分和ODI均低于术前，且术后6个月低于术后1周（均P＜0.05）； TLIF组术后1周和术后6个月VAS评分和ODI均低于PLIF组（均P＜0.05）。与TLIF组比较，PLIF组术后6个月腰椎前凸角较大（P＜0.05）；2组术后椎间隙高度、椎间融合率和并发症发生率比较差异均无统计学意义（均P＞0.05）。结论 TLIF和PLIF治疗单节段退变性腰椎管狭窄症均安全有效，PLIF减压更彻底，可以获得更好的腰椎前凸角，而TLIF损伤较小、恢复更快，各有优点和局限性，临床应根据患者特点选择合适的手术方式。

• Objective To investigate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) on treatment of monosegment degenerative lumbar spinal stenosis（LSS）. Methods From March 2016 to March 2021, 112 patients with monosegment degenerative LSS were selected from the 910th Hospital of Joint Logistic Support Force of the Chinese People′s Liberation Army. Patients were divided into TLIF group (55 cases) and PLIF group (57 cases) according to the operation approach. The operation time, intraoperative blood loss, postoperative drainage, pain visual analogue scale (VAS) score, Oswestry disability index (ODI), intervertebral space height, lumbar lordosis angle, intervertebral fusion rate and incidence of complications were compared between the two groups. Results The operation time in the TLIF group was shorter than that in the PLIF group［(132±30)min vs （215±43）min， t=11.812， P＜0.001］, the intraoperative blood loss and postoperative drainage in the TLIF group were less than those in the PLIF group［(284±48)ml vs （386±65）ml, （310±62）ml vs （344±52）ml］（t=9.410, 11.239, both P＜0.001）. The VAS score and ODI in the two groups were lower in 1 week and 6 months after operation, and the VAS score and ODI in 6 months after operation were lower than those in 1 week after operation (all P<0.05). The VAS score and ODI were lower in the TLIF group than those in the PLIF group in 1 week and 6 months after operation (all P<0.05). The lumbar lordosis angle in the PLIF group was larger than that in the TLIF group in 6 months after operation (P<0.05). There were no statistically significant differences in the intervertebral space height, intervertebral fusion rate and incidence of complications between the two groups (all P>0.05). Conclusions  TLIF and PLIF are both safe and effective on treatment of monosegment degenerative LSS. PLIF decompresses more thoroughly and gets better lumbar lordosis angle, while TLIF has less damage and quicker recovery. Each has its own advantages and limitations, and the appropriate surgical approach should be selected according to the characteristics of patients.