改良TLIF联合术中撑开复位治疗退变性腰椎滑脱症

目的探讨改良经腰椎椎间孔椎体间融合术（TLIF）联合术中撑开复位技术治疗退变性腰椎滑脱症的可行性及其临床疗效。方法回顾性分析2007年3月至2011年10月复旦大学附属华山医院采用改良TLIF联合术中撑开复位技术治疗的84例单节段退变性腰椎滑脱症患者的临床资料，评估手术前后视觉模拟量表（VAS）疼痛评分、日本骨科学会（JOA）评分、融合节段椎间隙高度、腰椎前凸度（Cobb角）和椎体滑脱程度，X线片或CT扫描观察患者术后3个月、1年的影像学融合情况。结果平均手术时间（170±38）min、术中平均失血量（274±82）mL。截至术后3个月，全部患者获得有效随访；截至1年，84例患者中获随访79~EJ（94％）。术后3个月及1年，融合节段椎间隙高度较术前有明显提高（JP〈0．05），但手术前后Cobb角无明显差异（P〉0．05）；术后3个月，腰椎滑脱完全复位34例（40％），余50例患者术后腰椎滑脱得到不同程度复位；术后1年，椎体滑脱程度改善率为84％。术后3个月及1年，患者VAS评分、JOA评分均较术前明显好转（P〈0．05）；根据JOA评估标准，优59例、良20例、可5例，平均改善率为87％。57例（68％）患者术后3个月达到影像学融合标准，79例（100％）患者术后1年达到影像学融合标准。患者均未出现神经根损伤、硬膜囊撕裂、椎弓根螺钉松动断裂、椎间融合器移位下沉等。结论改良TILF联合术中撑开复位治疗单节段退变性腰椎滑脱症安全有效。

Modified transforaminai lumbar interbody fusion with distraction reduction for the treatment of degenerative lumbar spondylolisthesis

Objective To study the feasibility and clinical effect of modified ~＇ansforaminal lumbar interbody fusion （TLIF） with distraction reduction for the treatment of degenerative lumbar spondylolisthesis. Methods Clinical data of 84 patients with single-level degenerative lumbar spondylolisthesis treated by modified TLIF and distraction reduction in Huashan Hospital affiliated to Fudan University from March 2007 to October 2011 were collected and analyzed retrospectively, preoperative and postoperative visual analogue scale （VAS） pain score, Japanese Orthopedics Association （JOA） score, intervertebral space height, the degrees of lumbar lordosis （Cobb angle） and spondylolisthesis were measured, the radiographic fusion condition was evaluated at 3 months and 1 year after the operation by X-ray or CT scanning. Results The average operating time was （170 ~ 38） rain, and the intraoperative estimate blood loss was （274 ~ 82） mL： All patients were followed up from 3 months after the surgery, and 79 patients were followed up to 1 year （79/84, 94%）. At three months and one year follow-up, the postoperative intervertebral space height recovered significantly （P 〈Z0.05）, however, there was no significant statistical difference between pre- and post-operative Cobb angle （P 〉0.05）. At three months follow-up, 34 patients got total reduction （40%）, along with partial reduction in the other 50 patients; at one year follow-up, the improvement rate of the degree of spondylolisthesis was 84%. Postoperative VAS pain scores and JOA scores improved significantly （P 〈0.05） compared with preoperative ones. According to JOA evaluation criteria, there were excellent in 59 cases, good in 20 cases, fair in 5 cases, with the average improvement rate of 87%. Three months after the operation, 57 of 84 patients （67.8%） had the radiographic fusion, and at one year follow-up, all 79 patients （100%） got the radiographic fusion. At one year follow-up, there was no complications such as nerve injuries, dural tear, pedicle screw loosening or breakage, interbody fusion cage displacement and subsidence. Conclusion Modified TLIF with distraction reduction is a relatively safe and easy-acceptable method, which always has a good clinical result for the patients with single-level degenerative lumbar spondylolisthesis.