退行性脊柱侧凸对MIS-TLIF治疗腰椎管狭窄症疗效影响

目的:评估退行性脊柱侧凸对微创经椎间孔入路腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎管狭窄症的手术难度及术后疗效的影响。方法:自2016年9月至2019年9月,采用MIS-TLIF手术治疗腰椎管狭窄症患者52例,男16例,女36例,年龄42～71(63.44±5.96)岁,病程1.5～6.5(3.69±1.10)年。52例患者均有下肢根性痛或麻木症状,其中41例患者有间歇性跛行症状。51例均为单节段狭窄,狭窄节段:L4,5节段31例,L5S1节段21例。依据是否合并退行性脊柱侧凸分为侧凸组18例(退行性脊柱侧凸合并腰椎管狭窄),狭窄组34例(单纯腰椎管狭窄)。记录围手术期相关数据和术后并发症,通过CT评估术后椎间植骨融合情况,采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估患者疼痛和腰椎功能改善情况。结果:51例患者均获随访,随访时间12～36(19.58±5.33)个月。手术时间、术中出血量狭窄组优于侧凸组(P0.05);两组间术后引流量、术后血红蛋白及C-反应蛋白、术后下地时间、出院时间、出院及随访时VAS评分、术后3个月及随访时ODI评分、术后并发症和椎间植骨融合率比较差异无统计学意义(P0.05)。结论:对于行MIS-TLIF手术的腰椎管狭窄症患者,退行性脊柱侧凸三维畸形,可导致手术时间延长,出血增多。但是对患者术后症状的缓解,并发症的发生和腰椎功能的恢复并无明显影响。

Influence of degenerative scoliosis on the treatment of lumbar spinal stenosis by MIS-TLIF

Objective: To evaluate the effect of degenerative scoliosis on the difficulty and efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar spinal stenosis.Methods: From September 2016 to September 2019,52 patients with lumbar spinal stenosis treated by MIS-TLIF were retrospectively analyzed,including 16 males and 36 females,aged from 42 to 71(63.44±5.96) years old,the course of disease from 1.5 to 6.5 years,with an average of (3.69±1.10) years. All patients had lower extremity root pain or numbness,41 patients had intermittent claudication. There were 31 cases of L_4,5 and 21 cases of L₅S₁. There were 18 cases in scoliosis group,lumbar spinal stenosis combined with degenerative scoliosis,and 34 cases in stenosis group,lumbar spinal stenosis alone. The perioperative data and postoperative complications were recorded,the postoperative interbody fusion was evaluated by CT,and the clinical outcomes were evaluated by VAS score,Oswestry Disability Index(ODI).Results: All patients were followed up for 12 to 36 months,with an average of (19.58±5.33) months. The operation time and intraoperative bleeding in stenosis group were better than those in scoliosis group(P<0.05). There were no significant differences in postoperative drainage volume,postoperative Hb,CRP,postoperative landing time,discharge time,VAS score at discharge and follow-up,ODI score at 3 months and follow-up,postoperative complications and interbody fusion rate between two groups(P>0.05).Conclusion: For patients with lumbar spinal stenosis undergoing MIS-TLIF,degenerative scoliosis can lead to prolonged operation time and increased bleeding. However,it has no significant effect on the relief of postoperative symptoms,postoperative complications and the recovery of lumbar function.