显微镜辅助Zista通道下MIS-TLIF治疗退行性腰椎滑脱症

目的:探讨显微镜辅助Zista通道下微创经椎间孔入路腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗Ⅰ、Ⅱ度退行性腰椎滑脱症的临床疗效及优势。方法:回顾性分析2017年1月至2018年3月采用显微镜辅助Zista通道下的MIS-TLIF手术治疗的18例退行性腰椎滑脱症患者的临床资料,其中男10例,女8例;年龄48~70岁,平均59岁;病程6个月~5年,平均33个月;L413例,L55例。Meyerding滑脱分度:Ⅰ度11例,Ⅱ度7例。记录围手术期观察指标;比较术前与术后各时点的腰腿痛视觉模拟评分(visual analogue scale,VAS),日本骨科协会(Japanese Orthopaedic Association,JOA)评分以评价临床症状及腰椎功能;术后第12个月时,根据影像学资料测量椎间隙高度,采用Brantigan-Steffee标准评估椎间融合情况;依照改良Macnab标准评定临床疗效。结果:所有患者顺利完成手术,术后获得12个月以上的随访。手术时间(160.45±34.98)min,术中出血量(88.32±21.12)ml,术后引流量(50.34±18.22)ml,术后下地时间(20.65±6.25)h。腰痛VAS评分术前(7.81±2.16)分与术后7 d(4.19±1.17)分、3个月(2.25±0.62)分、12个月(1.53±0.58)分比较,差异均有统计学意义(P<0.05);腿痛VAS评分术前(8.47±2.21)分与术后7 d(3.45±0.86)分、3个月(2.31±0.73)分、12个月(1.43±0.47)分比较,差异均有统计学意义(P<0.05);JOA评分术前(12.01±2.33)分与术后7 d(18.56±3.12)分、3个月(23.54±3.31)分、12个月(26.34±2.65)分比较,差异均有统计学意义(P<0.05)。椎间隙高度由术前的(4.46±0.72)mm增高到术后12个月时的(10.24±1.48)mm(P<0.05);所有手术节段成功融合,其中E级16例,D级2例;依照改良Macnab标准,结果优15例,良2例,可1例。结论:显微镜辅助Zista通道下的MIS-TLIF治疗Ⅰ、Ⅱ度退行性腰椎滑脱症中有着明显的微创优势,是一种安全有效的方法。

Treatment of degenerative lumbar spondylolisthesis with minimally invasive transforaminal lumbar interbody fusion by microscope assisted Zista channel

Objective:To investigate the clinical efficacy and advantage of minimally invasive transforaminal lumbar interbody fusion under microscope-assisted Zista channel in the treatment of degreeⅠandⅡdegenerative lumbar spondylolisthesis.Methods:The clinical data of 18 patients with degenerative lumbar spondylolisthesis treated by microscope-assisted Zista channel MIS-TLIF operation from January 2017 to March 2018 were analyzed retrospectively.There were 10 males and 8 females with an average age of 59 years(48 to 70).The course of spondylolisthesis ranged from 6 months to 5 years with an average of 33 months.The segment of spondylolisthesis was L4 in 13 cases and L5 in 5 cases.According to Meyerding spondylolisthesis criteria,11 cases were degreeⅠand 7 cases were degreeⅡ.The perioperative observation indexes were recorded.The VAS score and JOA score of lumbago and leg pain before and after operation were compared to evaluate the clinical efficacy.At 12 months after operation,the height of intervertebral space was measured by imaging data,the intervertebral fusion was evaluated by Brantigan-Steffee standard,and the curative effect was evaluated according to the modified Macnab standard.Results:All the patients completed the operation successfully and were followed up more than 12 months after operation.Operation time was(160.45±34.98)min,intraoperative blood loss was(88.32±21.12)ml,postoperative drainage volume was(50.34±18.22)ml,and walking time after operation was(20.65±6.25)h.Preoperative and postoperative at 7 days,3 months,12 months,VAS score of low back pain was 7.81±2.16,4.19±1.17,2.25±0.62 and 1.53±0.58 respectively,VAS score of leg pain was 8.47±2.21,3.45±0.86,2.31±0.73 and 1.43±0.47,JOA score was 12.01±2.33,18.56±3.12,23.54±3.31 and 26.34±2.65.There were significant differences in VAS and JOA scores between preoperative and postoperative(P<0.05).The height of intervertebral space increased from(4.46±0.72)mm preoperative to(10.24±1.48)mm at 12 months after operation(P<0.05).All operative segments got fusion(16 cases of grade E and 2 cases of grade D).According to Macnab standard,15 cases obtained excellent results,2 cases good,1 case fair.Conclusion:MIS-TLIF under microscope-assisted Zista channel has obvious minimally invasive advantages in the treatment of degreeⅠandⅡdegenerative lumbar spondylolisthesis,and it is a safe and effective method.