微创椎弓根螺钉内固定联合骶前间隙轴向融合治疗L_5椎体滑脱症的临床观察

目的前瞻性观察对L_5椎体滑脱症患者行微创经皮椎弓根螺钉内固定(MIPPSO)联合骶前间隙轴向椎间融合术(Axia LIF)治疗的有效性和安全性。方法笔者筛选2011年7月~2014年6月收治的Ⅱ度以内L_5椎体滑脱症患者36例,其中腰椎滑脱属创伤性者2例,峡部裂性者20例,老年退变性者14例。观察组(n=18例)行MIPPSO联合Axia LIF治疗,对照组(n=18例)行传统开放手术。观察两组比较患者术前及术后腰部疼痛视觉模拟量表(VAS)、影像Taillard指数、椎间隙高度、滑脱角、植骨融合情况,记录术中出血量、手术时间、随访并发症情况。结果 36例L_5S患者随访10~26个月,平均(13.87±6.17)个月。观察组vs对照组,平均手术时间(143.86±39.34)min vs(213.46±29.12)min;术中平均出血量(73.54±21.03)m L vs(101.31±25.31)m L;腰痛VAS评分术前为(7.28±1.49)分vs(9.11±2.03)分,末次随访为(0.65±0.78)分vs(2.12±0.91)分,术前与末次随访比较P0.05,以上三项指标观察组均低于对照组,差异明显具有统计学意义。18例L_5S患者术后半年CT扫描后三维重建可见完全骨性融合。影像学观察观察组vs对照组Taillard指数术前(0.1719±0.03821)vs(0.1632±0.04031)、术后1周(0.0697±0.008)vs(0.0783±0.007)、最后一次随访(0.0715±0.007)vs(0.0932±0.005)。滑脱角术前(5.28±1.41)°vs(5.32±1.29)°,术后1周(2.09±0.58)°vs(3.41±0.69)°,末次随访为(2.17±0.52)°vs(3.72±0.61)°。椎间隙高度为术前(4.81±1.52)mm vs(4.33±1.87)mm,术后1周(9.68±1.73)mm vs(7.73±2.15)mm,末次随访为(9.55±1.26)mm vs(7.45±1.96)mm。以上三个影像学观察指标术前与术后1周时比较P0.05。术后1周指标和最后随访指标观察组与对照组差异明显具有统计学意义(P0.05)。结论微创行经皮椎弓根螺钉内固定联合骶前间隙轴向椎间融合术对腰椎骨质损伤轻,愈合迅速且良好,治疗L_5椎体滑脱症效果理想。

Clinical observation of minimally invasive percutaneous pedicle screws osteosynthsis combined with axial lumbar interbody fusion for lumbar 5 spondylolisthesis

Objective To observe the efficacy and safety of minimally invasive percutaneous pedicle screws osteosynthsis ( MIPPSO ) combined with axial lumbar interbody fusion ( AxiaLIF ) for lumbar 5 spondylolisthesis (L5S).Methods Thirty-six cases of L5S below Ⅱdegree admitted in our hospital from Jul.2011 to Jun.2014 were screened out .There were 2 cases of traumatic lumbar spondylolisthesis , 20 cases of isthmus broken lumbar spondylolisthesis , and 14 cases of elderly degenerative lumbar spondylolisthesis .Among them 18 cases were treated with MIPPSO combined with AxiaLIF ( the observation group ) and another 18 were treated with traditional open sur-gery ( the control group ) .VAS score of low bac pain , Taillard index , intervertebral space height , slip angle and fu-sion were compared , and the blood loss ,operative time ,follow-up time and complications were recorded .Results All patients were followed up for 10 -26(13.87 ±6.17) months.The average operation time of the observation group and the control group was (143.86 ±39.34) min and (213.46 ±29.12)min, respectively.The mean blood loss of the observation group and the control group was (73.54 ±21.03) mL and (101.31 ±25.31) mL, respec-tively.VAS before the surgery in the observation group and the control group was (7.28 ±1.49) and (9.11 ± 2.03) , respectively, and (0.65 ±0.78) and (2.12 ±0.91) after surgery, and the difference before the surgery and after the surgery had statistical significance .There were significant differences among these three indicators ob-served before the surgeries and those observed 1 week after surgery and in the last follow-up.Complete bony fusions were shown in the three-dimensional reconstruction of the 18 patients after CT scan six months after the surgeries . The Taillard index of the observation group and the control group before the surgery was (0.1719 ±0.03821) and (0.1632 ±0.04031) , respectively, (0.0697 ±0.008) vs (0.0783 ±0.007) one week after the surgery and (0.0715 ±0.007) vs (0.0932 ±0.005) at the last follow-up.The slip angle before the surgery of the observation group and the control group was (5.28 ±1.41)°vs (5.32 ±1.29)°, respectively, and (2.09 ±0.58)°vs (3.41 ±0.69)°one week after the surgery and(2.17 ±0.52)°vs (3.72 ±0.61)°at the last follow-up.The interverte-bral space height before the surgery of the observation group and the control group was (4.81 ±1.52) mm vs (4.33 ±1.87) mm, respectively, (9.68 ±1.73) mm vs (7.73 ±2.15) mm one week after the surgery and (9.55 ± 1.26)mm vs (7.45 ±1.96)mm at the last follow-up.The above three indicators before surgery were all of statisti-cal significance (P<0.05)compared with those 1 week after the surgery.The above three indicators 1 week after the surgery in the observation group were all of statistical significance (P<0.05)compared with those in the control group .Conclusion Minimally invasive percutaneous pedicle screws osteosynthsis combined with axial lumbar inter -body fusion is minimally invasive and ideal in treating lumbar 5 spondylolisthesis with quick fusion and good results .