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

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。

The clinical efficacy of mini-invasive transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis

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.