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71.
目的:比较经多裂肌间隙入路椎间孔椎体间融合术(TLIF)和传统腰椎后路腰椎间融合术(PLIF)在腰椎间盘突出症的临床疗效。方法:选择腰椎间盘突出症的患者60例,根据手术方式不同随机分为两组(PLIF组和TLIF组),每组各30例。比较两组患者手术时间、术中出血量、术后引流量、术后住院天数、椎体间融合率、椎体融合时间以及术后并发症;手术前后VAS评分和ODI功能障碍指数评分。结果:①TLIF组的手术时间、术中出血量、术后引流量均比PLIF组明显降低(P0.05);两组术后住院时间、椎体间融合率和椎体融合时间比较无显著差异(P0.05)。②TLIF组术后VAS评分和ODI评分均比PLIF组明显降低;③TLIF组的术后神经损伤、固定物松动移位和硬脊膜撕裂脑脊液漏发生率均比PLIF组明显降低(P0.05)。结论:采用经多裂肌间隙入路TLIF技术治疗腰椎间盘突出症较传统PLIF技术疗效好、创伤小、出血少、术后并发症少,值得临床推广应用。 相似文献
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Mustafa Uysal Metin Ozalay Alihan Derincek Alauddin Kochai Mehmet Turker 《Acta orthopaedica et traumatologica turcica》2018,52(4):272-276
Objective
The aim of this study was to evaluate the effects of PLIF and TLIF on sagittal spinopelvic balance and to compare radiological results of two surgical procedures with regard to spinopelvic parameters.Methods
Thirty-five patients (34 female and 1 male; mean age: 52.29 ± 13.08 (range: 35–75)) with degenerative spondylolisthesis cases were included in the study. Patients were divided into two groups according to surgical technique: PLIF and TLIF. The level and the severity of listhesis according to Meyerding classification were assessed and spinopelvic parameters including sacral slope, pelvic tilt, pelvic incidence (PI), lumbar lordosis, and segmental lumbar lordosis were measured on digital X-rays. All preoperative and postoperative parameters and the results were compared between two groups.Results
The age distribution was similar in both groups (p = 0.825) and there was no difference between the mean PI of the groups (p = 0.616). In 15 patients, spondylolisthesis level were at the L5-S1 level (PLIF: 8, TLIF: 7), in 16 patients at the L4-L5 level (PLIF: 6, TLIF: 10) and in 4 patients at the L3-L4 level (PLIF: 2, TLIF: 2). According to Meyerding classification, before the operation, the sliding grades were 0 in 4 patients, 1 in 21 patients, 2 in 7 patients, and 3 in 3 patients. The grades changed into 0 in 28 patients, 1 in 5 patients, and 2 in 2 patients after surgery. There were no differences in the grade of listhesis between PLIF and TLIF groups preoperatively (p = 0.190) and postoperatively (p = 0.208). In both groups, the spondylolisthesis-related deformities of patients were significantly corrected after surgery (p < 0.001).Conclusion
PLIF and TLIF techniques have similar radiological results in restoring the sagittal spinopelvic balance in patients with degenerative spondylolisthesis. Both techniques are good options to achieve reduction and fusion in patients with degenerative spondylolisthesis, but have no advantage over each other for restoring spinopelvic balance.Level of evidence
Level III, Therapeutic study. 相似文献73.
Swamy Kurra William F. Lavelle Michael P. Silverstein Jason W. Savage R. Douglas Orr 《The spine journal》2018,18(6):1014-1021
Background Context
Patients with spinal deformity may present with complaints related to either the deformity itself or the manifestations of the coexisting spinal stenosis. There are reports of successful management of lumbar pathology in the absence of global sagittal or coronal imbalance, with limited decompression and fusion, addressing only the symptomatic segment.Purpose
Our study examined the long-term outcomes of transforaminal lumbar interbody fusion (TLIF), a less extensive procedure, based on the experience of the senior author over the past 10 years.Study Design/Setting
This was a retrospective study of symptomatic lumbar spinal stenosis and spinal deformity managed by one surgeon at The Cleveland Clinic since 2003.Patient Sample
Forty-one patients were included in the study.Outcome Measures
The present study measures the long-term clinical functional outcomes of these patients through EQ-5D (EuroQol five dimensions questionnaire), PHQ-9 (Patient Health Questionnaire), and PDQ (Pain Disability Questionnaire) forms, along with documented radiographic parameters and Charlson Comorbidity Index (CCI).Methods
There were no funding or potential conflicts of interest associated biases in the present study. Patients with symptomatic lumbar spinal stenosis with neutral global alignment in the sagittal and coronal planes and symptomatic stenosis at the deformity level were treated by limited fusion and TLIF, and had a follow-up period of at least 5 years. Excluded were patients under 18 years of age, had more than three levels of fusion, and had an active spinal malignancy or recent spinal trauma. The grouping variables were curve magnitude, revision surgeries, and TLIF levels. Clinical outcomes were compared in all the grouping variables. Analysis of variance (ANOVA) and chi-square tests were utilized; p<.05 was considered statistically significant.Results
The average age and follow-up period were 66±10 and 7.5 years, respectively. There was no statistical difference between patients with curves measuring between 10° and 20° and greater than 20° for EQ-5D, PHQ-9, and PDQ. Patients had worse PDQ data with larger curves compared with smaller curves at both 5 years and final follow-up. Although there was no statistical significance between preoperative coronal curve magnitude and revision surgeries, patients with curves greater than 20° had higher rates of revision surgeries (75%; p=.343) in the global lumbar curve deformity group. Although there was no statistical significance for patients who underwent revision surgeries,those patients had low PHQ-9 values at the final follow-up (p=.09). The revision surgery rate was 48% in one-level TLIF and 18% in two-level TLIF. Moderate pain disability scores were noticed for one-level TLIF patients (mean=75) compared with two-level TLIF patients (mean=27) at the final follow-up, and approached statistical significance in this comparison (p=.06).Conclusion
Although this topic has a limited audience to spinal deformity surgeons, the prevalence of patients who present with adult spinal deformities has been increasing. Short segment fusion, in the setting of modest spinal deformity, is a reasonable and safe option. Further study on the concept of short segment fusions in the growing patient population is required as more comprehensive fusions do have noted complication rates, and a compromise must be reached between the extent of surgery that is enough to provide pain relief and disability and the degree of surgery that is too much to be tolerated in terms of complication rates. 相似文献74.
目的探讨开放与微创TLIF术式对单节段腰椎退行性疾病患者围手术期临床指标、ODI评分及术后并发症的影响。方法选取我院2011年8月~2014年5月收治单节段腰椎退行性疾病患者共140例,以随机数字表法分为开放组(70例)和微创组(70例),分别采用开放与微创TLIF术式治疗;比较两组患者围手术期临床指标,术前、术后3,12,24个月VAS评分、JOA评分、ODI评分、椎间植骨融合率及术后并发症发生率等。结果两组患者手术用时比较,差异无统计学意义(P0.05);微创组患者术中出血量、术后出血量及术后首次下地活动时间均显著优于开放组(P0.05);微创组患者术后3个月VAS评分,JOA评分及ODI评分均显著优于开放组、术前(P0.05);两组患者术后12个月和24个月VAS评分,JOA评分及ODI评分比较,差异无显著性(P0.05);微创组患者术后椎间植骨融合率显著高于开放组(P0.05);两组患者术后并发症发生率比较,差异无统计学意义(P0.05)。结论微创TLIF术式治疗单节段腰椎退行性疾病患者手术创伤小,术后恢复时间短,可快速缓解腰腿疼痛,改善肢体活动功能,且未增加术后并发症发生几率,价值优于开放TLIF术式。 相似文献
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目的比较研究经椎间孔入路和后路椎间融合术治疗腰椎滑脱症的临床疗效、植骨融合率及术后并发症。方法 31例腰椎滑脱症的患者行椎间融合术附加双侧椎弓根螺钉固定术,PLIF组16例,TLIF组15例,比较两组的手术时间、术后并发症、临床疗效满意率和植骨融合率等。结果所有患者伤口均一期愈合。术后神经根痛加剧:PLIF组有3例,TLIF组1例。术中硬膜囊撕裂:PLIF组1例,TLIF组未出现该并发症。PLIF组临床疗效优良率为85.1%,而TLIF组优良率为90.2%,两者无显著性差异(P0.05)。植骨融合率:PLIF组植骨融合率为93.4%,TLIF组植骨融合率94.1%,两者无显著性差异(P0.05)。结论 PLIF和TLIF是治疗腰椎滑脱症的有效方法,两者在临床疗效满意率和植骨融合率方面没有显著性差异,但是在手术时间、创伤、并发症等方面,TLIF组明显优于PLIF。 相似文献
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Javier Rodríguez-Vela Antonio Lobo-Escolar Eduardo Joven Javier Muñoz-Marín Antonio Herrera José Velilla 《European spine journal》2013,22(12):2857-2863
Purpose
Supporters of minimally invasive approaches for transforaminal lumbar interbody fusion (TLIF) have reported short-term advantages associated with a reduced soft tissue trauma. Nevertheless, mid- and long-term outcomes and specifically those involving physical activities have not been adequately studied. The aim of this study was to compare the clinical outcomes of mini-open versus classic open surgery for one-level TLIF, with an individualized evaluation of the variables used for the clinical assessment.Methods
A prospective cohort study was conducted of 41 individuals with degenerative disc disease who underwent a one-level TLIF from January 2007 to June 2008. Patients were randomized into two groups depending on the type of surgery performed: classic open (CL-TLIF) group and mini-open approach (MO-TLIF) group. The visual analog scale (VAS), North American Spine Society (NASS) Low Back Pain Outcome instrument, Oswestry Disability Index (ODI) and the Short Form 36 Health Survey (SF-36) were used for clinical assessment in a minimum 3-year follow-up (36–54 months).Results
Patients of the MO-TLIF group presented lower rates of lumbar (p = 0.194) and sciatic pain (p = 0.427) and performed better in daily life activities, especially in those requiring mild efforts: lifting slight weights (p = 0.081), standing (p = 0.097), carrying groceries (p = 0.033), walking (p = 0.069) and dressing (p = 0.074). Nevertheless, the global scores of the clinical questionnaires showed no statistical differences between the CL-TLIF and the MO-TLIF groups.Conclusions
Despite an improved functional status of MO-TLIF patients in the short term, the clinical outcomes of mini-open TLIF at the 3- to 4-year follow-up showed no clinically relevant differences to those obtained with open TLIF. 相似文献78.
TLIF结合椎弓根钉内固定治疗峡部崩裂型腰椎滑脱症 总被引：1，自引：0，他引：1
目的：探讨经腰椎间孔入路腰椎体间植骨融合术治疗腰椎滑脱症的有效性及安全性。方法：手术治疗腰椎滑脱症12例。采用腰椎后正中切口,行相应节段椎弓根复位内固定,经单侧腰椎间孔入路腰椎体间植骨融合（TLIF）,并使用2枚钛网或单独进行自体髂骨植骨。术后随访观察椎体间植骨融合情况及临床效果,按JOA评分进行疗效评价。结果：全部患者切口一期愈合,无神经根损伤、椎间隙感染和脑积液漏等并发症。12例均获随访,随访时间7～17月,平均12个月。无1例发生内固定物松动移位或断裂,椎间隙高度无丢失。骨融合率为100%,疗效优良率91.6%。结论：TLIF结合椎弓根钉复位内固定治疗腰椎滑脱症是一种有效及安全的手术方式。 相似文献
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《Journal of Clinical Orthopaedics and Trauma》2020,11(5):910-915
PurposeOur aim is to examine the gender performance of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) scores among patients undergoing minimally invasive transforaminal lumbar fusion (MIS TLIF).MethodsA prospectively collected surgical dataset was retrospectively assessed for eligible patients from March 2015–June 2019. We included patients if they underwent primary MIS TLIF procedures on one or two vertebral levels. We collected baseline demographics, perioperative characteristics, and PROMIS-PF scores for each subject at pre and postoperative timepoints (e.g., 6-weeks, 3-months, 6-months, and 1-year). Chi-squared analyses were utilized to assess categorical variables and a Student’s t-tests analyzed continuous variables. A linear regression was used to analyze PROMIS-PF scores from baseline through all postoperative time points. Finally, we evaluated the PROMIS PF achievement of minimal clinically important difference (MCID) among gender.Results192 patients were included: 77 were females and 115 were males. No significant differences were observed among gender subgroups for PROMIS-PF scores at pre- or postoperative evaluations. Compared to males, females experienced significantly greater postoperative improvement with PROMIS-PF scores at the 3-month assessments, though no significant gender differences were observed during later follow-up evaluations at 6-months or one year. Females were observed to have significant PROMIS-PF score improvement from their preoperative evaluation to each postoperative score. Males were assessed to have statistically significant postoperative (e.g., at 3-months, 6-months, and 1-year) PROMIS-PF score improvement from their preoperative PROMIS-PF scores. There were no significant differences among gender in achieving MCID at any postoperative time interval.ConclusionAmong gender, we observed no statistically significant difference in PROMIS-PF scores during the pre- or postoperative evaluations. Additionally, with no difference in the rate of achieving PROMIS-PF MCID postoperatively, this study established that both genders should experience similar functional outcomes following MIS TLIF. 相似文献