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微创经椎间孔减压腰椎融合内固定手术与传统后路开放手术治疗老年腰椎退行性疾病患者的效果比较
穆胜凯 王景续 宫树一 沈永乐
沈阳市骨科医院脊柱外科,辽宁沈阳 110044
Effect comparison of minimally invasive surgery-ransforaminal decompression lumbar fusion and internal fixation and internal fixation with traditional open posterior approach for treatment of elderly patients with degenerative diseases of the lumbar spine
MU Shengkai WANG Jingxu GONG Shuyi SHEN Yongle
Department of Spine Surgery,Shenyang Orthopaedic Hospital,Liaoning Province,Shenyang 110044,China
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摘要 目的 比较微创经椎间孔减压腰椎融合内固定手术(MIS-TLIF)与传统后路开放手术治疗老年腰椎退行性疾病患者的效果。方法 选取2019年11月至2020年10月沈阳市骨科医院收治的120 例老年腰椎退行性疾病患者作为研究对象,采用随机数字表法将其分为对照组(n=60)和研究组(n=60)。对照组患者应用传统后路开放手术治疗,研究组患者应用MIS-TLIF 治疗。比较两组患者的临床指标,比较两组患者治疗前及治疗后1、3 个月的疼痛程度及生活质量。结果 研究组患者的手术时间为(138.1±32.4)min,住院时间为(7.4±3.0)d,均短于对照组的(145.2±32.8)min、(9.8±2.5)d,差异有统计学意义(P<0.05);研究组患者的术中出血量为(253.6±121.9)ml,术后引流量为(24.8±8.2)ml,均少于对照组的(384.5±148.7)、(279.4±51.5)ml,差异有统计学意义(P<0.05);研究组患者的切口长度为(2.0±0.4)cm,小于对照组的(7.6±1.2)cm,差异有统计学意义(P<0.05);研究组患者治疗后1、3 个月的视觉模拟评分(VAS)分别是(1.6±0.8)、(1.4±0.2)分,均低于对照组的(4.7±0.9)、(4.0±0.8)分,差异有统计学意义(P<0.05);研究组患者治疗后1、3 个月的Oswestry 功能障碍指数(ODI)评分分别是(34.1±4.2)、(28.6±3.4)分,均低于对照组的(38.3±4.3)、(33.1±3.6)分,差异有统计学意义(P<0.05);两组患者治疗后1、3 个月的VAS、ODI 评分均低于治疗前,差异有统计学意义(P<0.05);两组患者治疗后3 个月的VAS、ODI 评分均低于治疗后1 个月,差异有统计学意义(P<0.05)。结论 对老年腰椎退行性疾病患者应用MIS-TLIF 治疗,临床疗效较好,且能有效降低患者的疼痛感,提高患者生活质量,值得临床推广应用。
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穆胜凯
王景续
宫树一
沈永乐
关键词 微创经椎间孔减压腰椎融合内固定手术传统后路开放手术生活质量Oswestry 功能障碍指数    
Abstract:Objective To compare the effect of minimally invasive surgery-ransforaminal decompression lumbar fusion and internal fixation (MIS-TLIF) with traditional open posterior approach for the treatment of elderly patients with degenerative diseases of the lumbar spine.Methods A total of 120 elderly patients with degenerative diseases of the lumbar spine in Shenyang Orthopaedic Hospital from November 2019 to October 2020 were selected as the research subjects,and they were divided into the control group (n=60) and the study group (n=60) by the random number table method.The control group was treated with traditional open posterior approach,and the study group was treated with MIS-TLIF.The clinical indicators of the two groups were compared,and the pain degree and quality of life before treatment and 1,3 months after treatment of the two groups were compared.Results The operative time of patients in the study group was (138.1±32.4) min,and the hospital stay was (7.4±3.0) d,which were shorter than (145.2±32.8) min and (9.8±2.5) d in the control group,and the differences were statistically significant (P<0.05).The intraoperative blood loss of patients in the study group was (253.6±121.9) ml,and the postoperative drainage volume was (24.8±8.2) ml,which were lower than (384.5±148.7) and (279.4±51.5) ml in the control group,and the differences were statistically significant (P<0.05).The incision length in the study group was (2.0±0.4) cm,which was smaller than (7.6±1.2) cm in the control group,and the difference was statistically significant (P<0.05).The visual analog scale (VAS)scores of patients in the study group at 1 and 3 months after treatment were (1.6±0.8) and (1.4±0.2) points,respectively,which were lower than (4.7±0.9) and (4.0±0.8) points in the control group,and the differences were statistically significant (P<0.05).The Oswestry disability index (ODI) scores of patients in the study group at 1 and 3 months after treatment were (34.1±4.2) and (28.6±3.4) points,respectively,which were lower than (38.3±4.3) and (33.1±3.6) points in the control group,with statistically significant differences (P<0.05).The VAS and ODI scores at 1 and 3 months after treatment in the two groups were lower than those before treatment,and the differences were statistically significant (P<0.05).The VAS and ODI scores of the two groups at 3 months after treatment were lower than those at 1 month after treatment,and the differences were statistically significant (P<0.05).Conclusion The application of MIS-TLIF in the treatment of elderly patients with degenerative diseases of the lumbar spine has a good clinical effect,and can effectively reduce the pain of patients and improve the quality of life of patients,which is worthy of clinical application.
Key wordsMinimally invasive surgery-ransforaminal decompression lumbar fusion and internal fixation    Traditional open posterior approach    Quality of life    Oswestry disability index
    
作者简介: 穆胜凯(1984-),辽宁兴城人,硕士,副主任医师,研究方向:脊柱损伤的诊断与治疗。
引用本文:   
穆胜凯;王景续;宫树一;沈永乐. 微创经椎间孔减压腰椎融合内固定手术与传统后路开放手术治疗老年腰椎退行性疾病患者的效果比较[J]. 中国当代医药, 2022, 29(14): 86-89.
MU Shengkai;WANG Jingxu;GONG Shuyi;SHEN Yongle. Effect comparison of minimally invasive surgery-ransforaminal decompression lumbar fusion and internal fixation and internal fixation with traditional open posterior approach for treatment of elderly patients with degenerative diseases of the lumbar spine. 中国当代医药, 2022, 29(14): 86-89.
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