改良Wiltse入路经椎间孔入路腰椎椎间融合术与Quadrant通道下微创经椎间孔入路腰椎椎间融合术治疗腰椎退行性疾病

目的 对比分析改良Wiltse入路经椎间孔入路腰椎椎间融合术(TLIF)与Quadrant通道下微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗腰椎退行性疾病的临床疗效.方法 回顾性分析2019年1月—2020年1月在西南医科大学附属医院接受单侧单节段TLIF治疗的63例患者临床资料,根据手术方式分为改良Wilt...

Efficacy of transforaminal lumbar interbody fusion via modified Wiltse approach and minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel for lumbar degenerative diseases

Objective To compare and analyze the clinical efficacy of transforaminal lumbar interbody fusion(TLIF) via modified Wiltse approach and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) assisted by Quadrant channel in the treatment of lumbar degenerative diseases. Methods From January 2019 to January 2020, the clinical data of 63 patients who received unilateral single-segment TLIF in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed. According to surgical methods, they were divided into modified Wiltse approach TLIF group(group A, 33 cases) and MIS-TLIF assisted by Quadrant channel group(group B, 30 cases). The incision length, operation time, fluoroscopy frequency, intraoperative blood loss, postoperative drainage volume and related complications were recorded in both groups. Serum creatine kinase(CK) levels were measured at pre- and post-operation, and the clinical efficacy was evaluated by visual analogue scale(VAS) score and Oswestry Disability Index(ODI). Lumbar X-ray and CT three-dimensional reconstruction were performed at pre-operation, postoperative 1 week and 3, 6 and 12 months to determine the bone grafting fusion. The area atrophy ratio of multifidus muscle was measured and calculated on lumbar MRI at pre-operation and postoperative 12 months. Results All the operations were completed successfully, in which 1 case in group B was changed to open operation due to the occlusion of iliac crest. The patients were followed up for(24.3±8.7)months. Compared with group B, group A had longer incision length, fewer fluoroscopy frequencies, more intraoperative blood loss and postoperative drainage volume, and the differences were statistically significant(P < 0.05). There was no significant difference in operation time between the 2 groups(P > 0.05). CK levels at postoperative 1 and 3 d of group A were significantly lower than those of group B, the differences were statistically significant(P < 0.05). CK levels of 2 groups at postoperative 5 d were close to the preoperative normal value, and there was no statistically significant difference between the 2 groups(P > 0.05). The VAS score at postoperative 3 d of group A was lower than that of group B, and the VAS score and ODI at postoperative 3 months were lower than those of group B, all with a statistical significance(P < 0.05). At the final follow-up, there was no significant difference in bone grafting fusion and the area atrophy ratio of the multifidus muscle between the 2 groups(P > 0.05). One case of dural sac rupture in each group was cured after intraoperative repair and symptomatic treatment. In group B, there was 1 case of skin edge necrosis and 1 of fat liquefaction, and the wound healing was delayed after repeated dressing changes. Conclusions TLIF via modified Wiltse approach and MIS-TLIF assisted by Quadrant channel for treatment of lumbar degenerative disease both can obtain satisfactory clinical outcomes. The former has less intraoperative influence on the paravertebral muscle, while the latter has shorter incision, less intraoperative blood loss and postoperative drainage volume. In the application scenarios of different countries or regions, for different patients, we should pay attention to the development of personalized options.