微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究  

Clinical study on lumbar spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion

作　　者：王建[1] 周跃[1] 张正丰[1] 李长青[1] 任先军[1] 初同伟[1] 王卫东[1] 郑文杰[1] 潘勇[1] 黄博[1] 

机构地区：[1]第三军医大学重庆新桥医院骨科,400037

出　　处：《中华外科杂志》2011年第12期1076-1080,共5页Chinese Journal of Surgery

摘　　要：目的回顾性分析和比较微创经椎间孔腰椎间融合术（MIS—TLIF）和开放经椎间孔腰椎间融合术（OTLIF）治疗腰椎滑脱症的临床结果。方法自2006年6月至2010年5月，371例I°或Ⅱ°腰椎滑脱症患者接受TLIF和腰椎弓根螺钉固定治疗并获得随访，男性134例，女性237例；年龄37～85岁，平均50．4岁。采用可扩张通道下单节段TLIF和经皮椎弓根螺钉内固定治疗患者172例（MIS—TLIF组），传统开放TLIF和椎弓根螺钉内固定方法治疗患者199例（OTLIF组）。分析两组手术时间、术中术后出血、放射线暴露时间和并发症等方面的差异。采用视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评分评估临床结果，行腰椎动力位X线片和薄层CT扫描重建检查评价椎间融合情况。结果371例患者均获得随访，随访时间12～58个月，平均32．7个月。术前两组性别、年龄、滑脱类型和融合节段差异无统计学意义。术中出血MIS—TLIF组平均为（310±75）ml，OTLIF组（623±156）ml，MIS—TLIF组显著优于OTLIF组（t=2．836，P〈0．01）。术后出血MIS—TLIF组平均为（38±13）ml，OTLIF组（184±72）ml，MIS—TLIF组显著优于OTLIF组（t=3．274，P〈0．01）。与OTLIF组放射暴露时间（20±10）S比较，MIS—TLIF组放射暴露时间（51±19）s更长（t=2．738，P〈0．01）。两组在手术时间、腰痛VAS评分、ODI评分和并发症发生方面差异均无统计学意义。结论针对Ⅱ。以下腰椎滑脱症，MIS—TLIF安全有效，相对而言，与开放固定比较具有出血少及组织损伤轻优点。Objectives To retrospectively analyze the treatment of lumbar spondylolisthesis using minimally invasive and open transforaminal lumbar interbody fusion （TLIF）, and compare the clinical results of two techniques. Methods From June 2006 to May 2010, 371 patients with lumbar spondylolisthesis grade 1 and 2 were treated with TLIF, pedicle screw fixation and followed up. The mean age was 50. 4 years （range, 37-85 years）. There were 172 patients who underwent minimally invasive TLIF and percutaneous pedicle screw fixation were set as the MIS-TLIF group, 199 patients who underwent open TLIF and pedicle screw fixation were set as the OTLIF group. The operative time, blood loss, X-ray exposure time and complications were compared between the two groups. Clinical outcome was assessed using the visual analog scale （VAS） and the Oswestry disability index （ODI）. Fusion rates were deterufined by using CT scan reconstruction and dynamic lumbar radiography in last fellow-up. Results The average follow-up duration was 32. 7 months with a range of 12-58 months. The gender, age, classification of spondylolistheis and level of fusion showed a identical pattern in both groups. The mean intra-operative blood loss （310 ± 75 ） ml and postoperative blood loss （38 ± 13 ） ml in MIS-TLIF group were significantly superior to the intra-operative blood loss （623 ± 156） ml and postoperative blood loss （ 184 ±72 ） ml in OTLIF group （t = 2. 836 and 3. 274,P 〈 0. 01 ）. Comparing with the OTLIF group （20 ± 10）s, the MIS-TLIF group had a significantly longer radiation time （51 ± 19）s （t = 2. 738 ,P 〈 0. 01 ）. There was no statistical difference in operating time, lower back pain VAS scores, ODI scores and incidence of complication between the two groups. Conclusions Comparing with open TLIF, minimally invasive TLIF is a safe and reliable procedure for treatment of lumbar spondylolisthesis grade 1 and 2 with potential advantages.

关 键 词：脊椎滑脱 外科手术 微创性 腰椎 经椎间孔腰椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]