腰4、5退变性滑脱的相关解剖学和形态学参数的对比研究

目的观察成人退变性腰椎滑脱患者形态学参数和解剖学特征,探讨L4、L5退变性滑脱的差异性。方法回顾性分析124例退变性腰椎滑脱患者,男20例,女104例;年龄46~70岁(平均49.3岁);其中L4退变性滑脱103例,L5退变性滑脱21例;以75例年龄43~69岁(平均47.7岁)匹配的正常成人为对照组,男24例,女51例。在站立位全脊柱X线片上测量形态学参数:骨盆入射角(Pelvic incidence,PI)、骨盆倾斜角(Pelvic tilt,PT)、骶骨倾斜角(Sacral slope,SS)、腰椎前凸角(Lumbar lordosis,LL)、胸椎后凸角(Thoracic kyphotic,TK)和矢状面平衡(Sagittal vertical axis,SVA);解剖学参数:髂骨高度(Iliac crest height,ICH)、骶骨平台角(Sacral table angle,STA)、L4和L5椎体指数(Lumbar index,LI)、L4和L5椎体相对横突长度(Transverse process length,TPL)和横突宽度(Transverse process width,TPW)。采用独立样本检验比较滑脱组与对照组及滑脱组内L4退变组、L5退变组之间的差异。结果滑脱组脊柱骨盆参数PI、PT、SS、LL和SVA为(57.9±10.3)°、(18.4±7.4)°、(39.9±8.3)°、(54.7±10.9)°和(28.6±18.2)mm,明显正常高于对照组的(43.7±11.6)°、(13.7±6.9)°、(30.2±8.2)°、(48.3±10.1)°和(13.1±19.9)mm(0.05)。滑脱组解剖学参数L4TPW、L5TPW、L4LI、L5LI和STA分别为(0.17±0.06)、(0.16±0.04)、(0.84±0.09)、(0.83±0.07)和(89.7±4.8)°,显著低于对照组为(0.25±0.09)、(0.23±0.07)、(0.94±0.06)、(0.92±0.08)和(98.8±3.5)°(0.05),滑脱组L4TPL和L5TPL较正常对照组无显著差异(0.05)。滑脱组内,L4DS组和L5DS组ICH分别为(0.67±1.1)和(-1.1±0.98),L4退变组组ICH值显著高于L5退变组(0.05),其它脊柱骨盆参数和解剖学参数均未见显著差异(0.05)。结论腰椎DS发生可能与矢状面形态和腰骶部解剖学特征有关,而DS发生的节段与髂骨高度有关,较高的髂骨则保护了L5使得L4发生滑脱风险增高。     

Clinical and Radiographic Comparison of Oblique Lateral Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients with L4/5 grade-1 Degenerative Spondylolisthesis

Objectives

To compare the clinical and radiographic outcomes of oblique lateral lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in patients with grade-1 L4/5 degenerative spondylolisthesis.

Methods

Based on the inclusion and exclusion criteria, the comparative analysis included consecutive patients with grade-1 degenerative spondylolisthesis who underwent oblique LIF (OLIF, n = 36) or minimally invasive transforaminal LIF (MI-TLIF, n = 45) at the Department of Spine Surgery, Beijing Jishuitan Hospital from January 2016 to August 2017. Patient satisfaction Japanese Orthopaedic Association score, visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), radiographic outcomes including anterior/posterior disc heights (ADH/PDH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion, and fusion rate were assessed during a 2-year follow-up. Continuous data are presented as mean ± standard deviation and were compared between groups using the independent sample t-test. Categorical data are presented as n (%) and were compared between groups using the Pearson chi-squared test or Fisher's exact test. Repetitive measurement and analysis of variance was employed in the analysis of ODI, back pain VAS score, and leg pain VAS score. Statistical significance was defined as p < 0.05.

Results

The OLIF and MI-TLIF groups comprised 36 patients (age, 52.1 ± 7.2 years; 27 women) and 45 patients (age, 48.4 ± 14.4 years; 24 women), respectively. Satisfaction rates at 2 years post procedure exceeded 90% in both groups. The OLIF group had less intraoperative blood loss (140 ± 36 vs 233 ± 62 mL), lower back pain VAS score (2.42 ± 0.81 vs 3.38 ± 0.47), and ODI score (20.47 ± 2.53 vs 27.31 ± 3.71) at 3 months follow-up (with trends toward lower values at 2 years follow-up), but higher leg pain VAS scores at all postoperative time points than the MI-TLIF group (all p < 0.001). ADH, PDH, FD, and FW improved in both groups post-surgery. At the 2 year follow-up, the OLIF group had a higher rate of Bridwell grade-I fusion (100% vs 88.9%, p = 0.046) and lower incidences of cage subsidence (8.33% vs 46.67%, p < 0.001) and retropulsion (0% vs 6.67%, p = 0.046) than the MI-TLIF group.

Conclusions

In patients with grade-I spondylolisthesis, OLIF was associated with lower blood loss and greater improvements in VAS for back pain and ODI and radiologic outcomes than MI-TLIF. The OLIF is more suitable for these patients with low back pain as the main symptoms are accompanied by mild or no leg symptoms before operation.     

Correlation between fat infiltration of paraspinal muscle and L4 degenerative lumbar spondylolisthesis in asymptomatic adults

ObjectiveTo explore the relationship between different indicators of the degree of fat infiltration and L4 Degenerative lumbar spondylolisthesis (DLS).Methods128 patients received annual health check-up underwent lumbar lateral Digital Radiography (DR) and abdominal Computed tomography (CT) imaging were enrolled. The DLS group included 60 patients diagnosed with DLS, and the control group included 68 patients without DLS. The data collected included vertebral density of L4-L5, fat infiltration ratio (FIR) of paravertebral muscle (PM) and psoas major muscle (PMM), skeletal muscle density of PM and PMM, low attenuation muscle ratio (LTR) of PM and PMM, paraspinal muscle density (PMD), psoas major muscle density (PMMD), low attenuation muscle density (LMD) of PM and PMM, facet joint angle (FJA), facet joint degeneration (FJD), etc.ResultsPM FIR and PM LTR were weakly positively correlated with the degree of L4 DLS, and there was a weak negative correlation between PMD and the degree of L4 DLS in asymptomatic adults (P < 0.05). Logistic regression analysis showed that PM FIR was an independent related factor of L4 DLS (Q3 vs. Q1, OR = 3.746, 95% CI: 1.076–13.048, p = 0.038). ROC curve analysis showed that the PM FIR has a high predictive value for L4 DLS in asymptomatic adults.ConclusionThe indicator of PM FIR was an independent related factor of L4 DLS in asymptomatic adults. It has a high predictive value for L4 DLS and can be applied as a potential target for clinical treatment of L4 DLS in asymptomatic adults.     

腰椎后路减压+PLIF内固定术的手术护理

目的:探究腰椎后路减压+PLIF内固定术的手术护理。方法:选取55例进行PLIF治疗的腰椎滑脱患者,随机分成两组。观察组28例使用针对性护理,对照组27例使用常规护理,观察护理后患者的各项指标与生活质量。结果:观察组植骨融合率为96.43%,明显高于对照组的81.48%(P0.05);观察组下腰疼痛和功能障碍情况分别为10.71%、7.14%,明显优于对照组的25.93%和22.22%(P0.05);观察组并发症发生率为7.14%,明显低于对照组的14.81%(P0.05);观察组生存质量各项指标的发生率为17.86%,明显优于对照组的66.67%(P0.05)。结论:PLIF手术采用针对性护理效果良好,不良病症明显减少,改善了病人的生活质量,值得推广应用。     

脊柱-骨盆矢状面参数在双节段腰椎滑脱症患者手术前后的变化趋势及对手术疗效的评估价值

目的:探究脊柱-骨盆矢状面参数在双节段腰椎滑脱症患者手术前后的变化趋势及评估手术疗效的价值。方法:回顾性分析2019年10月至2020年10月采用后路腰椎椎体间融合术治疗的95例双节段腰椎滑脱患者,其中男31例,女64例;年龄41～63(52.10±4.35)岁;病变程度,Ⅰ度47例,Ⅱ度48例。术后3个月根据Oswestry功能障碍指数(Oswestry dysfunction index,ODI)改善率评定手术疗效,ODI改善率≥50%为良好,<50%为不良。95例根据手术疗效分为疗效良好组(74例)和疗效不良组(21例)。比较两组患者的临床资料,包括性别、年龄、身体质量指数、病程、病变程度、手术时间、术中出血量、合并症;观察术前及术后3个月脊柱-骨盆矢状面参数,包括脊柱骶骨角(spinosacral angle,SSA),T1骨盆角(T1 pelvic angle,TPA),腰椎前凸角(lumbar lordosis,LL),骨盆投射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),骶骨倾斜角(sacral slope,SS);采用视...     

To fuse or not to fuse: The elderly patient with lumbar stenosis and low-grade spondylolisthesis. Systematic review and meta-analysis of randomised controlled trials

BackgroundThe optimum surgical intervention for elderly patients with lumbar spinal stenosis (LSS) and low-grade degenerative-spondylolisthesis (LGDS) has been extensively debated. We conducted a systematic review and meta-analysis of randomised-controlled-trials (RCTs) comparing the effectiveness of decompression-alone against the gold-standard approach of decompression-with-fusion (D + F) in elderly patients with LSS and LGDS.MethodsA systematic literature search was performed on published databases from inception to October-2021. English-language RCTs of elderly patients (mean age over-65) with LSS and LGDS, who had undergone DA or D + F were included. The quality and weight of evidence was assessed, and a meta-analysis performed.ResultsSix RCTs (n = 531; mean age: 66.2 years; 57.8% female) were included. There was no difference in visual-analogue-scale (VAS) scores of back-pain (BP) or leg-pain (LP) at mean follow-up of 27.4 months between both DA and D + F groups (BP: mean-difference (MD)0.24, 95%CI: ?0.38–0.85; LP MD:0.39, 95%CI: ?0.34–1.11). No difference in disability, measured by Oswestry-Disability-Index scores, was found between both groups (MD:0.50, 95%CI: ?3.31–4.31). However, patients in DA group had less hospital complications and fewer adverse events (total-surgical-complications OR:0.57, 95%CI: 0.36–0.90), despite a higher rate of worsening DS (OR:3.49, 95%CI: 1.05–11.65). No difference in BP or LP was found in subgroup-analysis of open-laminectomy compared to posterolateral-fusion (PLF) (BP: MD: ?0.24, 95%CI: ?1.80–1.32; LP MD:0.80, 95%CI: ?0.95–2.55).ConclusionsDA is not inferior to D + F in elderly patients with LSS and LGDS. DA carries a lower risk of hospital complications and fewer adverse events, however, surgeons should weigh these findings with the increased risk of DS progressing post-operatively.     

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 transforam-inal 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Zist...     

后外侧入路经皮内窥镜下腰椎椎间融合术治疗腰椎滑脱症的临床疗效分析

目的:分析后外侧入路经皮内窥镜下腰椎椎间融合术(posterolateral endoscopic lumbar interbody fu-sion,PELIF)治疗腰椎滑脱症的安全性和早期疗效.方法:回顾性分析2018年3月～2019年9月我科行PELIF治疗的22例轻度腰椎滑脱症患者.其中男性9例,女性13例;年龄...