| 经椎间孔腰椎椎体间融合术治疗单节段退变性腰椎滑脱的疗效分析 |
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| 引用本文： | 周超,田永昊,郑燕平,刘新宇,王虎虎. 经椎间孔腰椎椎体间融合术治疗单节段退变性腰椎滑脱的疗效分析[J]. 山东大学学报(医学版), 2015, 53(12): 71-75. DOI: 10.6040/j.issn.1671-7554.0.2014.985 |
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| 作者姓名： | 周超 田永昊 郑燕平 刘新宇 王虎虎 |
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| 作者单位： | 山东大学齐鲁医院骨科, 山东济南 250012 |
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| 摘 要： | 目的 比较微创经椎间孔腰椎椎体间融合术(MIS-TLIF)Wiltse入路与正中入路治疗单节段退变性腰椎滑脱的疗效。方法 单节段退变性腰椎滑脱症患者70例,随机分为Wiltse入路组(n=32)和正中入路组(n=38)。Wiltse入路组随访12~24个月,平均18.6个月;正中入路组随访12~22个月,平均16.1个月。术后3、6、12个月随访,评估JOA腰痛评分、腰痛及下肢痛VAS,行影像学检查评估椎间融合及多裂肌萎缩程度。结果 两组性别、年龄、滑脱部位、滑脱程度、JOA腰痛评分、腰痛及下肢痛视觉模拟评分(VAS)差异无统计学意义(P>0.05)。两组平均手术时间差异无统计学意义(P>0.05)。与正中入路组相比,Wiltse入路组手术切口长度小、显露时间短、显露出血量及总出血量少,差异有统计学意义(P<0.05)。术后12个月随访,两组JOA腰痛评分及各项VAS评分均较术前改善,差异有统计学意义(P<0.05);两组间JOA腰痛评分、改善率和下肢痛VAS差异无统计学意义(P>0.05)。术后12个月随访时,Wiltse入路组腰痛VAS低于正中入路组,MRI肌萎缩评分高于正中入路组,差异有统计学意义(P<0.05)。结论 两种入路TLIF治疗单节段退变性腰椎滑脱手术疗效相近,但Wiltse入路对多裂肌的损伤比后正中入路小,术后腰背痛等并发症的发生率低。
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| 关 键 词： | Wiltse入路 经椎间孔椎体间融合术 脊椎前移 脊柱融合术 肌萎缩 |
| 收稿时间： | 2014-12-22 |
The clinical efficacy of mini-invasive transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis |
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| ZHOU Chao,TIAN Yonghao,ZHENG Yanping,LIU Xinyu,WANG Huhu. The clinical efficacy of mini-invasive transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis[J]. Journal of Shandong University:Health Sciences, 2015, 53(12): 71-75. DOI: 10.6040/j.issn.1671-7554.0.2014.985 |
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| Authors: | ZHOU Chao TIAN Yonghao ZHENG Yanping LIU Xinyu WANG Huhu |
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| Affiliation: | Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China |
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| Abstract: | Objective To compare the clinical efficacy of mini-invasive transforaminal lumbar inter-body fusion (MIS-TLIF) through Wiltse approach and traditional approach for the treatment of lumbar spondylolisthesis. Methods A total of 70 patients with lumbar spondylolisthesis were randomly divided group A (n=32) receiving MIS-TLIF through Wiltse approach and group B (n=38) receiving MIS-TLIF through traditional approach. In group A, the affected level was L4/5 in 20 cases and L5/S1 in 12 cases; 9 cases had only low back pain (LBP), while 21 cases had both LBP and leg pain; 17 cases had grade I and 14 cases had grade Ⅱ spondylolisthesis. In group B, the affected level was L4/5 in 22 cases and L5/S1 in 16 cases; 11 cases had only LBP, while 27 cases had both LBP and leg pain; 21 cases had grade I and 17 cases had grade Ⅱ spondylolisthesis. The JOA score, VAS of LBP and leg pain were evaluated 3 months, 6 months and 1 year after surgery. The post-operative dynamic X-rays, CT and/or MR were used for imaging evaluation. Results There was no difference in gender, age, affected levels, degree of spondylolisthesis, pre-operative JOA score, VAS of LBP, and VAS of leg pain between groups A and B (P>0.05). The incision length, blood loss and exposure time of group A were better than those of group B (P<0.05). The post-operative JOA scoresand VAS of LBP and leg pain were significantly improved after surgery in both groups A and B. The VAS of LBP in group A was lower than that of group B on day 1, day 14, and 1 year after surgery (P<0.05). The interbody fusion rate was not significantly different between groups A and B (P>0.05). There were no complications of internal fixation in both groups. Conclusion MIS-TLIF through both Wiltse and traditional approaches can acquire satisfactory clinical efficacy. Mini-invasive TLIF through Wiltse approach can significantly reduce the damage of multifidus and postoperative incidence of chronic LBP. |
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| Keywords: | Spinal fusion Wiltse approach Spondylolisthesis Muscular atrophy Transforaminal lumbar interbody fusion |
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