经Wiltse入路椎间孔椎体间融合术治疗腰椎滑脱合并腰椎管狭窄的疗效

目的探讨经椎旁肌间隙(Wiltse)入路椎间孔椎体间融合术(TLIF)治疗腰椎滑脱合并腰椎管狭窄的效果。方法选取腰椎滑脱合并腰椎管狭窄患者107例,按治疗方案不同分为Wiltse入路组(n=53)和传统入路组(n=54)。Wiltse入路组采取Wiltse入路TLIF,传统入路组采取传统后正中入路TLIF。对比2组患者手术情况,术后1年疗效、椎体融合率,术前及术后1 d、3 d血清促肾上腺皮质激素(ACTH)、肿瘤坏死因子-α(TNF-α)、皮质醇(Cor)水平,术前及术后6个月、1年腰、腿痛视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI),术前及术后6个月椎旁肌组织面积。结果Wiltse入路组患者手术时间短于传统入路组(P<0.05),术中出血量、术后引流量低于传统入路组(P<0.05);2组患者术后1年疗效、椎体融合率比较,差异无统计学意义(P>0.05);2组患者术后1 d、3 d血清ACTH、Cor、TNF-α水平较术前升高,但Wiltse入路组低于传统入路组(P<0.05);2组患者术后6个月、1年腰、腿痛VAS评分、ODI较术前降低,JOA评分较术前提高,且Wiltse入路组术后6个月腰、腿痛VAS评分、ODI低于传统入路组,JOA评分高于传统入路组(P<0.05);Wiltse入路组术后6个月左、右侧椎旁肌组织面积大于传统入路组(P<0.05)。结论Wiltse入路TLIF与传统后正中入路TLIF治疗老年腰椎滑脱合并腰椎管狭窄效果相当,但Wiltse入路可减少术中出血,且手术创伤相对更小、术后应激反应水平更低,可在短期内促进腰椎功能改善。

Effect of transforaminal lumbar interbody fusion by Wiltse approach in treatment of patients with lumbar spondylolisthesis and lumbar spinal stenosis

Objective To investigate the effect of transforaminal lumbar interbody fusion(TLIF)by Wiltse approach in the treatment of lumbar spondylolisthesis combined with lumbar spinal stenosis.Methods A total of 107 elderly patients with lumbar spondylolisthesis combined with lumbar spinal stenosis were selected and divided into Wiltse approach group(n=53)and traditional approach group n=54)according to different treatment plan.Patients in the Wiltse approach group received TLIF by Wiltse approach,and those in the traditional approach group received TLIF by traditional posterior median approach.The operation situation,the efficacy and the fusion rate of centrum 1 year after the operation,the serum levels of adrenocorticotropic hormone(ACTH),tumor necrosis factor-α(TNF-α),cortisol(Cor)before operation and 1 day,3 days after the operation,visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score,Oswestry dysfunction index(ODI)before operation and 6 months and 1 year after the operation,areas of paravertebral muscle tissue before operation and 6 months after operation were compared between two groups.Results The operation time of the Wiltse approach group was shorter than that of the traditional approach group(P<0.05),and the intraoperative blood loss and postoperative drainage volume were lower than those in the traditional approach group(P<0.05).There was no statistically significant difference in the efficacy or the fusion rate of centrum 1 year after the operation between two groups(P>0.05).The serum levels of ACTH,Cor and TNF-α1 day and 3 days after operation were higher than those before the operation in two groups,but those in the Wiltse approach group was lower than the traditional approach group(P<0.05).The VAS scores of the waist and leg,and ODI 6 months and 1 year after the operation were lower than those before the operation in two groups,and the JOA scores were higher than those before the operation;the VAS scores of the waist and leg and ODI 6 months in the Wiltse approach group were lower than those in the traditional approach group and JOA score was higher than that in the traditional approach group(P<0.05).The areas of left and right paraspinal muscle tissues in the Wiltse approach group were larger than those in the traditional approach group 6 months after operation(P<0.05).Conclusion The effect of TLIF by Wiltse approach is similar to that of TLIF by traditional posterior median approach in the treatment of elderly patients with lumbar spondylolisthesis and lumbar spinal stenosis,but Wiltse approach can reduce intraoperative blood loss and the surgical trauma with a lower postoperative stress response level,which can promote the improvement of lumbar function in a short time.