POSTEROLATERAL, POSTERIOR AND MI-TRANSFORAMINAL LUMBAR INTERBODY FUSION: A STUDY OF 212 CASES

ABSTRACT Objective: Degenerative disc disease is a common problem that could require surgical treatment. The aim of this study was to compare clinical outcomes, complications and benefits associated with intersomatic fusions by the MI-TLIF, PLIF and PLF techniques. Methods: A total of 212 patients were retrospectively reviewed. All patients underwent the same pre- and postoperative clinical evaluations using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and SF-36. Follow-ups were performed for at least one year. Inpatient days, complications, blood loss and operative times were equally quantified. Results: Estimated blood loss for MI-TLIF was statistically lower compared to the amount of blood recovered by Cell Saver device on PLIF and PLF groups. Mean surgical time for MI-TLIF were not significantly different compared to PLIF and PLF groups. Inpatient days were significantly lower in the MI-TLIF group, with an average decrease of one day. Four complications were recorded in the PLIF group, 2 in the PLF group, and one in the MI-TLIF group. Analysis of the clinical parameters revealed post-operative improvements at all time points, with the most statistically significant differences occurring at the first six months. Better results were achieved with the MI-TLIF technique. Conclusions: Compared to more invasive techniques, MI-TLIF showed fewer complications, less blood loss and shorter hospitalization times. Longer operative times in this group can be explained by the greater technical complexity and incipient learning curves. Interbody fusion by PLIF, PLF and MI-TLIF provided good clinical outcomes, but faster recovery was obtained with less invasive techniques. Level of evidence: III; Type of study: Retrospective comparative case study.

摘要
目的：退行性椎间盘疾病是临床常见病症，部分患者需接受手术干预。本研究旨在比较经MI-TLIF、PLIF及PLF术式实施椎间融合术的临床疗效、并发症及获益情况。
方法：本研究回顾性分析了212例患者的临床资料。所有患者均采用统一的术前及术后临床评估方案，评估工具包括奥斯威思特利功能障碍指数（Oswestry Disability Index, ODI）、视觉模拟评分法（Visual Analog Scale, VAS）及SF-36。随访时长至少为1年。同时量化统计了患者的住院天数、并发症发生情况、失血量及手术时长。
结果：统计结果显示，MI-TLIF组的估算失血量经统计学分析显著低于PLIF组与PLF组经自体血液回收机（Cell Saver）回收的血量。MI-TLIF组的平均手术时长与PLIF、PLF组相比无显著统计学差异。MI-TLIF组的住院天数显著更短，平均缩短1天。PLIF组共记录4例并发症，PLF组2例，MI-TLIF组1例。临床参数分析显示，各时间点术后均出现症状改善，其中术后6个月时的统计学差异最为显著。MI-TLIF术式可获得更优的临床效果。
结论：与侵入性更高的其他术式相比，MI-TLIF的并发症更少、失血量更低且住院时长更短。该组手术时长较长，可由其更高的技术复杂度与初始学习曲线加以解释。PLIF、PLF及MI-TLIF三种椎间融合术均可获得良好的临床疗效，但采用微创术式可实现更快的术后恢复。
证据等级：Ⅲ级；研究类型：回顾性对照病例研究。