经椎间孔入路腰椎椎间融合术中融合器位置对融合器沉降的影响

目的评估经椎间孔入路腰椎椎间融合术(TLIF)中融合器位置对融合器沉降发生率的影响。方法回顾性分析2010年1月—2014年12月接受L_4/L_5单节段TLIF的83例腰椎退行性疾病患者的临床和影像学资料。根据术后即刻CT平扫上融合器与L_5椎体上终板的相对位置,将患者分为中央组(37例)与边缘组(46例),比较2组患者手术前后影像学参数(椎间隙高度、椎间孔高度、腰椎局部前凸角)及疼痛视觉模拟量表(VAS)评分等指标。结果2组患者术后即刻、末次随访时椎间隙高度、椎间孔高度及腰椎局部前凸角较术前明显升高,差异均有统计学意义(P 0.05);末次随访时,中央组患者椎间隙高度、腰椎局部前凸角较术后即刻均有明显丢失,差异均有统计学意义(P 0.05);末次随访时,边缘组患者椎间隙高度、腰椎局部前凸角显著高于中央组,差异均有统计学意义(P 0.05)。末次随访时,2组患者腰痛及下肢痛VAS评分较术前均明显改善,差异有统计学意义(P 0.05),但组间比较差异无统计学意义(P 0.05)。末次随访时共18例发生融合器沉降,中央组12例(32.4%),1例重度沉降,11例轻度沉降;边缘组6例(13.0%)均为轻度沉降,2组沉降率差异有统计学意义(P 0.05)。结论 TLIF中融合器位于终板中央区域会增加术后融合器沉降发生率,术中置入融合器时应放置于终板边缘区域,以降低术后融合器沉降的风险。     

双枚融合器行腰椎椎间融合术治疗腰椎退行性疾病的疗效

目的 探讨双枚融合器行腰椎椎间融合术(PLIF)治疗腰椎退行性疾病的疗效。方法 将60例腰椎退行性疾病患者根据PLIF术中置入融合器数量的不同分为双枚组(30例)和单枚组(30例)。比较两组疼痛VAS评分、ODI评分、椎间隙高度、腰椎局部前凸角、椎间融合及融合器沉降情况。结果 患者均获得随访，时间1～3年。末次随访时，两组腰痛及下肢痛VAS评分、ODI评分均较术前明显改善(P<0.05),但组间比较差异均无统计学意义(P>0.05)。椎间隙高度及腰椎局部前凸角：两组术后7 d、末次随访时较术前均明显改善(P<0.05);末次随访时，单枚组较术后7 d均有明显丢失(P<0.05),双枚组较术后7 d均无明显丢失(P>0.05),双枚组均显著优于单枚组(P<0.05)。末次随访时，椎间融合率单枚组低于双枚组(P<0.05),融合器沉降率单枚组高于双枚组(P<0.05)。结论 双枚融合器行PLIF治疗腰椎退行性疾病可降低术后融合器的沉降发生率，提高椎间融合率，良好维持术后椎间隙高度及腰椎局部前凸角。     

腰椎终板形态对经椎间孔腰椎椎间融合术后融合器沉降的影响

目的 探讨不同腰椎椎间形态对经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion, TLIF)后融合器沉降发生的影响。方法 回顾性分析2019年1月至2021年8月接受单节段TLIF治疗的90例腰椎退行性疾病患者的临床和影像资料。根据影像资料，将患者分为沉降组43例，其中男15例，女28例，平均年龄(53.56±8.2)岁；未沉降组47例，其中男8例，女39例，平均年龄(58.26±13.53)岁。比较两组患者术前、术后、末次随访的影像参数(椎间隙高度、局部前凸角、终板形态参数、骨赘程度等)。再将患者分为无骨赘组46例，其中男15例，女31例，平均年龄(50.43±8.76)岁；骨赘组44例，其中男8例，女36例，平均年龄(61.84±11.18)岁。比较两组患者末次沉降度的差异。结果 所有患者顺利完成手术，术后随访12～27个月，平均(14.5±3.6)个月。沉降组的椎体前缘骨赘、终板形态较未沉降组的退变程度更高；沉降组的椎间隙矫正度高于未沉降组；骨赘程度与沉降度呈负相关。以上差异有统计学意义(P<0.05)。结论 终板形态不规则...     

经椎间孔椎间融合术联合Wiltse入路椎弓根固定治疗腰椎间盘突出症

[目的]比较经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF,A组)联合Wiltse入路椎弓根固定与传统经后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF,B组)治疗腰椎间盘突出症的临床疗效。[方法]2008年3月～2012年9月,本院接受腰椎间盘突出症手术治疗的186例患者分为两组,A组104例,男48例,女56例;年龄43～65岁,平均55岁。B组82例,男39例,女43例;年龄45～67岁,平均57岁。比较两种手术出血量、手术时间、并发症率、融合率、椎间隙高度情况,术前、术后随访均应用腰痛和腿痛视觉模拟(visual analogue pain score,VAS)评分、Oswestry功能障碍指数(oswestry disability index,ODI)评分评估患者的恢复情况,并进行统计分析。[结果]两组患者在年龄、性别、术前椎间隙高度、术前腰腿疼痛VAS评分和ODI评分方面相比均无统计学差异(P>0.05)。A组平均随访26个月,B组平均随访23个月,两组间无统计学差异。A组末次随访腿痛VAS评分、ODI评分、融合率、椎间隙高度与B组相比无显著性差异(P>0.05)。A组在出血量、手术时间、并发症发生率、末次随访腰痛VAS评分方面明显优于B组(P<0.01)。两组末次随访椎间隙高度、腰腿痛VAS评分及ODI评分与术前比较有显著性改善(P<0.01)。[结论]经椎间孔腰椎椎间融合术联合Wiltse入路椎弓根固定与传统经后路腰椎椎间融合术治疗腰椎间盘突出症均取得满意疗效,但具有创伤小、并发症少、腰痛残留率低等优点。     

腰椎间盘突出症单侧经椎间孔腰椎椎间融合术后对侧椎间孔形态变化分析

目的探讨腰椎间盘突出症单侧经椎间孔腰椎椎间融合术(Transforaminal lumbar interbody fusion,TLIF)术后对侧椎间孔形态变化的规律。方法回顾性分析自2018-06—2019-10采用TLIF治疗的72例单节段腰椎间盘突出症患者的临床资料,其中52例术后手术节段对侧椎间孔面积增大(增大组),20例术后手术节段对侧椎间孔面积减小(减小组)。比较2组末次随访时P-SAP、IPV-SAP、PDH、SA、FA,比较2组融合器深度、融合器角度及P-SAP、IPV-SAP、PDH、SA、FA变化率,比较2组术后1周及末次随访时背痛VAS评分、腿痛VAS评分、ODI指数。结果 72例均顺利完成手术并获得至少6个月的随访。2组融合器深度比较差异无统计学意义(P0.05),增大组融合器角度较减小组大,差异有统计学意义(P0.05)。末次随访时2组P-SAP、IPV-SAP、PDH、SA比较差异无统计学意义(P0.05),增大组FA较减小组高,差异有统计学意义(P0.05)。减小组P-SAP、IPV-SAP、FA变化率较较增大组大,SA变化率较增大组小,差异有统计学意义(P0.05)。相关性分析结果显示,减小组SA变化率与FA变化率呈负相关,增大组PDH变化率与IPV-SAP、SA、FA呈正相关(P0.05)。2组术后1周及末次随访时背痛VAS评分、腿痛VAS评分、ODI指数比较差异无统计学意义(P0.05)。结论单侧TLIF术对侧椎间孔面积减小与手术节段的腰椎前凸角过度增大有关,而椎间融合器的角度可能是影响手术节段腰椎前凸角的主要因素。     

经椎间孔腰椎椎体间融合联合单侧椎弓根钉棒固定术后融合器沉降及其对临床疗效的影响

目的 :观察经椎间孔腰椎椎体间融合(transforaminal lumbar interbody fusion,TLIF)联合单侧椎弓根钉棒内固定术后融合器沉降情况及其与临床疗效的相关性。方法:回顾分析2014年1月～2015年1月行TLIF+单侧椎弓根钉棒内固定术的43例退变性腰椎疾病患者,融合节段数51个。随访时间23.8±3.7个月(19～28个月)。通过腰椎CT测量并比较患者术前及术后融合节段椎间高度的变化,测量时间点分别为术前、术后即刻、术后半年、术后1年及末次随访时。根据椎间高度丢失的程度将融合器沉降分为0级(0～24%)、Ⅰ级(25%～49%)、Ⅱ级(50%～74%)和Ⅲ级(75%～100%)。统计、分析总体融合器沉降度在术后半年、1年及末次随访时的变化情况。根据融合器前后径及融合节段的长度,分别将患者分为32mm组(n=15)、36mm组(n=28)及单节段组(n=35)、双节段组(n=8),分析各组间术后半年、术后1年及末次随访时融合器沉降度是否存在统计学差异。统计43例患者术前和术后半年、1年及末次随访时的VAS评分及Oswestry功能障碍指数(Oswestry disability index,ODI),采用Pearson系数分析末次随访时融合器沉降与VAS评分、ODI的相关性。结果 :末次随访时88.2%(45/51)的融合节段融合器沉降等级为0级,11.8%(6/51)的融合节段沉降等级为Ⅰ级,无Ⅱ级或Ⅲ级沉降的患者。术后半年融合器沉降程度[(9.6±3.4)%]与术后1年融合器沉降程度[(14.2±5.6)%]比较有统计学差异(P0.05),而术后1年与末次随访时的融合器沉降程度无统计学差异(P0.05)。术后1年及末次随访时32mm组患者的融合器沉降程度大于36mm组(P0.05),单节段组和双节段组的融合器沉降程度无统计学差异(P0.05)。术后半年、1年及末次随访时腰腿痛VAS评分与术前比较显著降低(P0.05),ODI明显改善(P0.05)。末次随访时的腰痛VAS评分与融合器的沉降程度呈弱相关性(Pearson相关系数为0.334,P0.05),而腿痛VAS评分及ODI与融合器沉降无明显相关性(P0.05)。结论:TLIF联合单侧椎弓根钉棒内固定术后融合器沉降的程度低,且多数发生在术后1年内。在条件允许的情况下尽量选择前后径大的融合器以降低融合器沉降度,而手术节段的长短(单节段或双节段)对融合器沉降无明显影响。腰痛VAS评分与融合器沉降度存在弱相关性。     

斜侧方/经椎间孔入路腰椎椎间融合术治疗退行性腰椎滑脱的近期疗效

目的　比较斜侧方入路腰椎椎间融合术(OLIF)与经椎间孔入路腰椎椎间融合术(TLIF)治疗退行性腰椎滑脱(DLS)的近期疗效。方法回顾性分析海军军医大学附属长征医院2018年1月—2018年6月收治的30例DLS患者临床资料,其中采用OLIF治疗15例(OLIF组)、采用TLIF治疗15例(TLIF组)。记录2组手术时间、术中出血量、椎间融合、椎间孔高度及椎间高度恢复情况等;采用疼痛视觉模拟量表(VAS)评分评估腰腿疼痛程度;采用Oswestry功能障碍指数(ODI)评估术后功能恢复情况。结果所有手术顺利完成。所有患者随访(8.5±2.3)个月,末次随访时OLIF组均获得椎间融合,TLIF组1例未完全融合。OLIF组手术时间、术中出血量均少于TLIF组,差异有统计学意义(P 0.05)。2组术后1 d及末次随访VAS评分、ODI均较术前显著改善,差异有统计学意义(P 0.05);术后1 d及末次随访VAS评分组间相比差异无统计学意义(P 0.05);OLIF组术后1 d及末次随访ODI优于TLIF组,差异有统计学意义(P 0.05)。2组术后1 d及末次随访椎间孔高度及椎间高度均较术前明显改善,且术后1 d时OLIF组优于TLIF组,差异均有统计学意义(P 0.05)。结论 2种术式治疗DLS近期临床疗效良好。OLIF创伤小,ODI、椎间和椎间孔高度恢复优于TLIF。     

TLIF术后融合器下沉的危险因素调查

目的 调查经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion, TILF)术后融合器下沉的危险因素。方法 选择2018年9月～2020年8月本院采用TILF手术治疗的93例腰椎退行性疾病患者,平均随访(18.12±4.12)个月,记录术后融合器下沉情况,并通过单因素及多因素分析,调查TLIF术后融合器下沉的危险因素。结果 93例术后,22例(23.66%)发生融合器下沉。下沉组与未下沉组患者的术后椎间隙高度、术后节段前凸角、骨密度、融合器位置、年龄、手术节段差异有统计学意义(P<0.05);Logistic回归分析显示,术后椎间隙高度>12 mm、术后节段前凸角>20°、骨量低下、融合器位于终板中央区域是TLIF术后融合器下沉的危险因素。结论 TLIF术后部分患者会出现融合器下沉情况,术后椎间隙高度过高、术后节段前凸角过大、骨量低下、融合器位于终板中央区域会增加融合器下沉风险。     

经椎间孔与经后外侧入路椎间融合术治疗退变性腰椎滑脱症的疗效比较

目的比较经椎间孔腰椎椎间融合术(TLIF)和后外侧腰椎椎间融合术(PLIF)治疗退变性腰椎滑脱症(DLS)的临床疗效和影像学变化。方法收集2008年3月—2014年3月在本院采用TLIF(n=64)和PLIF(n=52)治疗的退变性腰椎滑脱症患者的临床资料,包括疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、融合率和医源性神经功能损伤(INRD)情况,以及手术节段滑脱程度、腰椎前凸角度、椎间隙后缘高度、椎间孔高度。结果两组的融合率和神经功能恢复情况差异无统计学意义(P0.05)。两种术式术后VAS评分、ODI改善率差异无统计学意义(P0.05)。术后PLIF组术侧神经功能损伤发生率高于TLIF组,差异有统计学意义(P0.05);对侧肢体的神经功能损伤发生率TLIF组高于PLIF组,差异有统计学意义(P0.05)。末次随访时,TLIF组在维持局部腰椎前凸角度方面优于PLIF组,差异有统计学意义(P0.05);PLIF组在恢复椎间隙后缘高度、椎间孔高度方面优于TLIF组,差异有统计学意义(P0.05)。结论 TLIF及PLIF在INRD发生率,恢复局部腰椎前凸角度、椎间孔高度及椎间隙高度方面各有优劣,医师可根据患者病情及自身情况选择合适入路进行手术。     

两种椎间融合术治疗单节段腰椎退行性疾病的疗效比较

目的 比较斜外侧腰椎椎间融合术(OLIF)与微创经椎间孔椎间融合术(MIS-TLIF)治疗单节段腰椎退行性疾病的疗效。方法 将40例非手术治疗无效的单节段腰椎退行性疾病患者根据治疗方式不同分为OLIF组(采用OLIF治疗，20例)和MIS-TLIF组(采用MIS-TLIF治疗，20例)。记录两组手术情况，测量手术前后腰椎前凸角和椎间隙高度，采用JOA评分、疼痛VAS评分及ODI评估手术效果。结果 患者均获得随访，时间12～16个月。手术时间、术中出血量OLIF组短(少)于MIS-TLIF组(P<0.05)。椎间隙高度、腰椎前凸角、疼痛VAS评分、ODI、JOA评分两组术后均较术前改善(P<0.05),术后椎间隙高度、腰椎前凸角OLIF组均优于MIS-TLIF组(P<0.001),术后疼痛VAS评分、ODI、JOA评分两组比较差异均无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论 OLIF与MIS-TLIF治疗单节段腰椎退行性疾病均能取得满意的疗效，OLIF术中出血量更少，在恢复腰椎前凸角及椎间隙高度方面更有优势。     

Unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion for treatment of lumbar foraminal stenosis

BACKGROUND CONTEXTTransforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw fixation (BPSF) is an effective treatment for lumbar foraminal stenosis (LFS). However, the effects of TLIF with unilateral pedicle screw fixation (UPSF) on LFS treatment have not been clearly elucidated.PURPOSEWe conducted this study to compare clinical outcomes and radiographic results of TLIF with UPSF and BPSF 2 years after the surgical treatment.DESIGNProspective randomized study.PATIENT SAMPLEThis study included 23 patients undergoing TLIF with UPSF and 25 patients undergoing TLIF with BPSF.OUTCOME MEASURESClinical outcomes were evaluated by visual analog scale (VAS) for low back pain and leg pain and Oswestry Disability Index (ODI) score. Radiographic outcomes included foraminal height, disc space height, segmental lordosis, and final fusion rates.METHODSThe clinical and radiographic outcomes were compared between the UPSF and BPSF group. The postoperative improvements were evaluated in either group. Intraoperative data such as duration of operation and estimated blood loss were collected. This study was registered at clinicaltrials.gov.RESULTSAnalysis of the VAS and ODI scores showed significant improvements in clinical outcomes within each group. No significant differences between the 2 groups were noted in the improvements of the VAS and ODI scores. The mean operative duration and blood loss were significantly greater in the BPSF group than in the UPSF group. There were significant improvements in the height of the foramen and intervertebral space and segmental lordosis in both groups, while there was no significant difference between the groups in amount of the improvements. No significant difference was found in the final fusion rates.CONCLUSIONSTLIF is an appropriate procedure for LFS treatment. With balanced intervertebral support using a cage, UPSF could achieve similar and satisfactory effects on lumbar segmental stability and fusion compared to BPSF. The unilateral approach appears to be associated with slightly shorter operative time and less blood loss.     

Comparing the medium-term outcomes of lumbar interbody fusion via transforaminal and oblique approach in treating lumbar degenerative disc diseases

BACKGROUND CONTEXTOblique lumbar interbody fusion (OLIF) has been proven to be effective in treating lumbar degenerative disorders (LDDs) via indirect decompression. However, its superiority over transforaminal lumbar interbody fusion (TLIF) remains questionable, especially in terms of medium-term follow-up.PURPOSETo compare the medium-term clinical and radiological outcomes of TLIF and OLIF in treating patients with LDDs.STUDY DESIGNRetrospective comparative study.PATIENT SAMPLEFifty-two patients treated by TLIF and forty-six patients treated by OLIF.OUTCOME MEASURESClinical records including the visual analog scale (VAS) score of the lower back and leg and the Oswestry Disability Index (ODI). Radiological records including disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), the cross-sectional area (CSA) of the spinal canal, and fusion rate. Surgical-related information and complications were also recorded.METHODSA retrospective review was performed on patients who were surgically managed for LDDs at L4–5 between 2015 and 2017 and completed at least 4 years of follow-up. A total of 98 patients were analyzed, with 46 patients treated by OLIF combined with anterolateral single screw-rod fixation (OLIF-AF group), and 52 patients treated by TLIF (TLIF group). Parameters including postoperative outcomes and perioperative complications were compared with evaluate the efficacy of the two approaches.RESULTSThere was significantly less bleeding, surgical duration, and hospitalization in the OLIF-AF group than in the TLIF group. Significant improvements in the clinical score were achieved in both groups. However, the VAS score of the lower back was significantly higher in the TLIF group than in the OLIF-AF group throughout the whole follow-up period. Significantly higher expansion of the CSA was found in the TLIF group than in the OLIF-AF group. However, the improvements in DH, LL, and SL were significantly lower in the TLIF group. The fusion rate was significantly higher in the OLIF-AF group than in the TLIF group within 6 months postoperatively, and there was no significant difference between the two groups at the final record. No significant difference was found in the rate of overall complications between the two groups (25.0% vs. 23.9%, p=.545). The intraoperative complication rate in the TLIF group (13.5%) was slightly higher than that in the OLIF-AF group (6.5%) (p=.257). There was no significant difference in the incidence of adjacent segment disorder (ASD) between the two groups (7.7% vs. 10.9%, p=.422). Cage subsidence was slightly lower in the TLIF group (5.8%) than in the OLIF-AF group (13.0%) (p=.298).CONCLUSIONSBoth the TLIF and OLIF-AF approaches demonstrated good medium-term outcomes in treating LDDs. Compared with TLIF, OLIF-AF showed advantages in postoperative recovery, improvement of intervertebral space and lumbar sagittal balance, and early intervertebral fusion but was associated with inferior spinal canal decompression efficacy. The two approaches shared comparable overall complication rates. However, OLIF-AF tended to have fewer intraoperative complications, and a higher incidence of subsidence.     

Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

OBJECT: A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance. To the authors' knowledge, there has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters. The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis. METHODS: The medical records and radiographs of 32 patients undergoing ALIF and 25 patients undergoing TLIF from between 2000 and 2004 were retrospectively reviewed. Clinical data and radiographic measurements, including preoperative and postoperative foraminal height, local disc angle, and lumbar lordosis, were obtained. Statistical analyses included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed. RESULTS: Our results indicate that ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The ALIF procedure increased foraminal height by 18.5%, whereas TLIF decreased it by 0.4%. In addition, ALIF increased the local disc angle by 8.3 degrees and lumbar lordosis by 6.2 degrees, whereas TLIF decreased the local disc angle by 0.1 degree and lumbar lordosis by 2.1 degrees. CONCLUSIONS: The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.     

Restoration of lordosis and disk height after single‐level transforaminal lumbar interbody fusion

Objective: To study radiographic and clinical outcomes after transforaminal lumbar interbody fusion (TLIF) in order to determine the impact of TLIF on lumbar lordosis, intervertebral height and improvement in clinical outcome measures. Methods: Forty‐five patients who had undergone a single‐level TLIF procedure for a single‐level degenerative condition were retrospectively reviewed and their clinical histories, degree of pre‐ and post‐operative lumbar lordosis, intervertebral height, and cage position recorded. Clinical assessment included use of modified Odom's criteria and a visual analog scale (VAS) for back and leg pain. Results: At 21 months, the patients had gained an average of 3.6° of lumbar lordosis and 4.5 mm disc height. Change in disc height was significantly associated with an anterior cage position while lumbar lordosis was unaffected by cage position. A spondylolisthesis subgroup demonstrated 31% reduction in the magnitude of anterior slip. Less lordosis was associated with worse back and leg pain as assessed by VAS and greater disk heights were associated with higher Odom's criteria scores. Patients with persistent leg pain at final follow‐up had less lumbar lordosis and intervertebral height than patients without leg pain. Conclusions: Intervertebral height and lumbar lordosis reconstruction are important for achieving good surgical results; guidance regarding the likely changes in lumbar lordosis and disk height after TLIF is provided by our findings.     

小切口短节段TLIF治疗腰椎退变性侧凸的早期疗效

目的探讨小切口短节段经椎间孔腰椎椎间融合（TLIF）技术治疗腰椎退变性侧凸（LDS）的早期疗效。方法 2011年1月至2012年12月广州医科大学附属第一医院采用小切口短节段TLIF治疗26例LDS患者。按视觉模拟量表（VAS）评分标准评估患者术后疼痛缓解情况,比较手术前后冠状面Cobb角、腰椎前凸角的差异,评估末次随访VAS评分改善率、Cobb角矫正率及腰椎前凸角改善率,计算末次随访椎间融合率。结果随访时间6~17个月（平均12.1个月）。术后6个月和末次随访时,VAS评分分别为（3.0±0.8）分和（3.0±1.1）分,较术前的（8.0±0.9）分明显降低（P〈0.05）;末次随访VAS评分改善率为62.5%。末次随访Cobb角较术前有明显改善[（7.7±2.8）°vs（17.3±5.5）°,P〈0.05],矫正率为55.5%;末次随访腰椎前凸角明显优于术前[（36.8±4.5）°vs（18.1±4.6）°,P〈0.05],改善率为103.3%。末次随访植骨融合率达100%。结论小切口短节段TLIF治疗LDS早期疗效确切,可有效缓解患者腰腿痛症状,纠正侧凸并改善腰椎前凸,椎间融合率高。     

经前侧方腹膜后入路腰椎椎间融合术治疗腰椎退行性疾病的临床疗效

目的探讨经前侧方腹膜后入路腰椎椎间融合术(OLIF)治疗腰椎退行性疾病的临床疗效。方法 2015年11月—2016年9月,本院采用OLIF治疗腰椎退行性疾病患者16例。记录患者手术前后日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分、椎间隙和椎间孔高度及并发症发生情况,以评价手术疗效。结果 16例患者均在OLIF微创管道下顺利完成所有手术,随访时间7~17个月。所有患者术后复查均未见椎弓根钉松动、断裂或Cage移位。至末次随访,仅1例椎间隙尚未融合,其余所有节段均已融合;2例Cage下沉,未见置入物松动;切口均一期愈合。所有患者术后腰椎JOA、VAS评分均优于术前,差异具有统计学意义(P0.05);术后椎间隙前缘、后缘及椎间孔高度均优于术前,差异具有统计学意义(P0.05)。结论 OLIF手术效果佳、并发症少,是治疗腰椎退行性疾病的一种较好的方法。     

改良Jaslow法与传统经椎间孔椎间融合术治疗单节段腰椎管狭窄症的对比研究

背景:改良Jaslow法已应用于腰椎管狭窄症(LSS)的治疗,临床效果良好,但目前尚无改良Jaslow法与传统经椎间孔椎间融合术(TLIF)临床疗效对比的相关研究。目的:探讨改良Jaslow法治疗单节段LSS的应用效果,并与传统TLIF进行对比研究。方法:回顾性分析2016年1月至2017年7月行手术治疗的65例单节段LSS患者,其中改良Jaslow组35例,男11例,女24例,年龄41~71岁,平均(54.2±9.3)岁;传统TLIF组30例,男10例,女20例,年龄44~80岁,平均(52.6±9.6)岁。所有患者随访18~30个月,平均(25.2±4.2)个月。对比两组患者的年龄、性别、体重指数(BMI)、手术时间、术中出血量、并发症等临床资料;采用术前、术后1周及末次随访的腰痛和腿痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、SF-36调查问卷评估临床疗效;比较椎间隙高度(IH)、腰椎前凸角(LL)、融合节段的前凸角(SL)、椎间融合器下沉值(CS)、椎间融合器沉降率(SR)等影像学参数。结果:两组患者的性别、年龄、手术时间、出血量比较,差异无统计学意义(P>0.05)。两组术后1周及末次随访的腰痛VAS、腿痛VAS、ODI较术前均有明显改善(P<0.05),但两组间差异无统计学意义(P>0.05)。两组末次随访的SF-36较术前均有明显改善(P<0.05),但两组间差异无统计学意义(P>0.05)。两组术后1周及末次随访的LL、SL与术前比较,差异均无统计学意义(P>0.05),两组间差异亦无统计学意义(P>0.05)。两组术后1周及末次随访的IH较术前均明显升高(P<0.05)。改良Jaslow组术后1周及末次随访的IH均高于传统TLIF组(P<0.05)。改良Jaslow组的CS和SR为(0.8±0.5)mm和5.7%,低于传统TLIF组的(1.2±1.0)mm和26.7%(P<0.05)。末次随访时,两组患者的手术节段均获得骨性融合。结论:与传统TLIF相比,改良Jaslow法治疗单节段LSS并不增加手术时间和出血量,且在恢复IH、降低CS和SR上具有优势。