Comparison of clinical outcomes of minimally invasive transforaminal lumber interbody fusion and posterior lumbar interbody fusion for lumbar disc herniation in obese patients
Wang Yapeng, Zhang Wei, An Jilong, Sun Yapeng, Ding Wenyuan, Shen Yong
Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
摘要目的 比较微创经椎间孔椎间融合术(MIS-TLIF)与传统腰后路椎间融合术(PLIF)治疗肥胖患者腰椎间盘突出症(LDH)的临床疗效。方法 回顾性分析2009年1月—2014年3月河北医科大学第三医院手术治疗的62例肥胖患者LDH的临床资料。患者BMI均≥28 kg/m2。按手术方式的不同,将62例患者分为MIS-TLIF组(30例)与PLIF组(32例)。术前2组患者血清肌酸激酶(CK)水平、疼痛视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分差具有可比性。所有患者术后随访6个月,比较2组患者手术时间、术中出血量、术后引流量、术后卧床时间及术后并发症发生情况;同时采用疼痛VAS评分、ODI、JOA、血清CK水平对患者临床疗效进行评价。结果 与PLIF组相比,MIS-TLIF组手术时间较长[(154±54)min vs (103±31)min,t′=4.489,P＜0.01],但术中出血量较少[(134±20)mL vs (357±43)mL,t′=26.350,P＜0.01],术后引流量较少[(48±13) mL vs (375±26)mL,t′=61.730,P＜0.01],术后卧床时间较短[(4.8±1.3)d vs (8.7±2.9)d,t′=6.760,P＜0.01]。与PLIF组相比较,MIS-TLIF组术后第1、3、5天血清CK水平明显降低(P值均＜0.01),术后第3天及3、6个月MIS-TLIF组腰背痛VAS评分低(P值均<0.01),术后3、6个月MIS-TLIF组ODI差异无统计学意义(P值均>0.05),术后3、6个月MIS-TLIF组JOA评分增加(P值均<0.01)。PLIF组有3例患者切口延迟愈合,其中感染1例;MIS-TLIF组未出现相关并发症。结论 与传统PLIF手术相比,MIS-TLIF术式治疗肥胖患者腰椎间盘突出症安全、有效。既具有创伤小、恢复快等优点,又可以减少术后腰背痛及术后切口并发症的发生率。
Abstract：Objective To compare the clinical outcomes of minimally invasive transforaminal lumber interbody fusion(MIS-TLIF) and posterior lumbar interbody fusion(PLIF) in obese patients (BMI≥28 kg/m2) with lumbar disk herniation(LDH).Methods A retrospective study of 62 obese patients from January 2009 to March 2014 with LDH was performed at the Third Hospital of Hebei Medical University. According to the surgical approach they underwent, 62 patients were divided into two groups, 32 underwent PLIF, and 30 underwent MIS-TLIF. Before surgery, there were no differences between MIS-TLIF group and PLIF group in terms of the level of serum creatine kinase (CK), visual analogue scale (VAS) scores, Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) scores (all P values>0.05).All enrolled patients were followed up for 6 months after operation. The operative time, intraoperative blood loss, postoperative drainage volume and postoperative bedtime were recorded and compared. Meanwhile, the back pain VAS, ODI, JOA scores and serum CK level were also recorded and compared to evaluate the clinical effects. Postoperative complications were also recorded and compared between two groups.Results Compared with PLIF group, the operative time was longer than that in MIS-TLIF group, [(154±54)min vs (103±31)min, t′=4.489, P<0.01]. But the intraoperative blood loss[(134±20) mL vs (357±43)mL, t′=26.350, P<0.01], postoperative drainage volume[(48±13) mL vs (375±26)mL, t′=61.730, P<0.01] and postoperative bedtime[(4.8±1.3)d vs (8.7±2.9)d, t′=6.760, P＜0.01] were less than that in PLIF group. Compared with PLIF group, the levels of serum CK were lower than that in MIS-TLIF group on 1, 3 and 5 days after surgery (all P values <0.01), and the back pain VAS scores were lower than that in MIS-TLIF group on the 3rd day, 3 and 6 months after surgery (all P values). At the 3- and 6- month follow-up, the ODI showed no significant difference between the two groups (all P values >0.05). At the 3- and 6- month follow-up, the mean JOA score in MIS-TLIF group was significantly higher than that in PLIF group (all P values<0.01). Three patients with delayed union(one patient had wound infection) in PLIF group, and there were no other complications in both groups.Conclusions Obese patients can achieve good efficacy with MIS-TLIF or PLIF treatment, but MIS-TLIF treatment shows shorter operation time, less trauma and bleeding volume, less incidence of short-term pain, low complication rate and faster postoperative recovery.
王亚朋, 张为, 安纪龙, 孙亚澎, 丁文元, 申勇. 微创经椎间孔与传统腰后路椎间融合术治疗肥胖患者腰椎间盘突出症的疗效比较[J]. 中华解剖与临床杂志, 2015, 20(6): 494-498.
Wang Yapeng, Zhang Wei, An Jilong, Sun Yapeng, Ding Wenyuan, Shen Yong. Comparison of clinical outcomes of minimally invasive transforaminal lumber interbody fusion and posterior lumbar interbody fusion for lumbar disc herniation in obese patients. Chinese Journal of Anatomy and Clinics, 2015, 20(6): 494-498.
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