两种TLIF手术方法治疗腰椎滑脱合并椎管狭窄症的疗效比较

目的比较两种TLIF手术方法治疗腰椎滑脱合并椎管狭窄症的临床疗效。方法回顾性分析及随访53例腰椎滑脱伴椎管狭窄症患者，其中A组（22例）采用Wiltse人路经椎间孔椎体间融合（transforaminal lumbar interbody fusion，TLIF）＋椎管潜行减压术，B组（31例）采用后正中入路改良经椎间孔椎体间融合＋椎管潜行减压术。记录两组的手术时间、术中出血量、术后引流量、JOA腰痛评分、疼痛视觉模拟评分（visnal analogue scale，VAS）、影像学评价，并进行统计分析。结果A组术中出血量、术后引流量均小于B组（P〈0．05），两组手术时间差异无统计学意义。在VAS评分及JOA评分方面，术后各时期较术前均有显著改善（P〈0．05），术后1周B组的腰痛VAS评分和JOA评分较A组差异有统计学意义（P〈0．05）。两组影像学评价差异无统计学意义（P〉0．05）。结论Wiltse入路组术中出血量及术后引流量少，患者术后腰腿疼痛缓解迅速，但远期的随访评分与后正中入路组比较无明显差异。改良TLIF在保持腰椎术后生物力学恢复方面优于常规TLIF。

The comparison of the clinical efficacy of two kinds of TLIF surgery for lumbar spondilolisbesis with stenosis

Objective To compare the clinical efficacy of two kinds of TLIF surgery for lumbar spondilolisbesis with stenosis. Methods A retrospective analysis of 53 patients about lumbar spondilolisbesis with stenosis was used. The patients in group A （n=22） was managed by TLIF via Wihse approach, the patients in group B （n=31） was managed by TLIF via posterior midline approach. The operating time, blood loss, postoperative drainage, visnal analogue scale （VAS） score, Japanese Orthopaedic Association （JOA） score, imaging evaluation were recorded, then they were put into statistical analysis. Results Blood loss and postoperative drainage in group B were higher than those in group A （P〈0.05）. There was no statistical difference in the operating time （P〉0.05）. Compared pre-operation with postoperation,there were statistical differences in the VAS scores and JOA scores between the two groups at the same time （P〈0.05）, the two groups showed significant differences on the VAS score and JOA score in tow back pain of one week post-operatively （P〈0.05）. There was no significant difference on imaging evaluation. Conclusion The Wihse approach has less intra-operative blood loss, postoperative drainage on and faster postoperative recovery,but there are no statistical differences at the final follw-up. The modified TLIF is better than the conventional TLIF at lumbar spine biomeehanics recovery.