单侧椎弓根螺钉固定TLIF术治疗老年退行性腰椎滑脱的疗效分析  

Clinical outcomes of unilateral instrumented transforaminal lumbar interbody fusion in the treatment of the lumbar degenerative spondylolisthesis in aged patients with a 2-4 year follow-up

作　　者：陈子贤[1] 梁运[1] 蒋淳[1] 冯振洲[1] 曹渊武[1] 姜晓幸[1] 

机构地区：[1]复旦大学附属中山医院骨科

出　　处：《老年医学与保健》2015年第2期104-108,共5页Geriatrics & Health Care

摘　　要：目的 回顾性评价单侧椎弓根螺钉固定经椎间孔椎体间融合（transforaminal lumbar interbody fusion,TLIF）术或合并对侧经椎板关节突螺钉（translaminar facet screw,TLFS）治疗老年患者退行性腰椎滑脱中期随访的临床效果.方法 2009年1月至2012年6月,收集65岁及以上罹患腰椎退行性滑脱伴腰椎管狭窄的患者29例,男性11例,女性18例;年龄65～ 81岁,平均（73.1±6.1）岁;其中单节段患者16例,双节段患者13例;平均随访时间为39.4±9.8个月（24 ～ 54月）.单节段患者采用旁正中入路行单侧椎弓根螺钉固定TLIF术,双节段患者在进行单侧双节段椎弓根置钉固定TLIF术后合并对侧TLFS术.记录手术时间、出血量、住院时间及相关并发症;评价手术前后ODI、VAS及JOA评分;使用X线摄片及三维CT评价节段融合情况及矢状位队列情况.结果 平均手术时间为99.5±32.3 min（单节段86.3±25.5 min,双节段115.8±32.4 min）,平均住院为12.9±3.7d（单节段12.8 ±2.0d,双节段13.1±5.1d）,平均出血量为210.3±181.0 mL（单节段195.0±192.0 mL,双节段229.2±164.5 mL）,并发症发生率为10.3％,24个月时滑脱节段融合率为89.7％.术后ODI、VAS及JOA评分改变较术前有统计学差异,术后腰椎前凸角及滑脱节段前凸角较术前增加（32.0±13.8）°vs （36.5±11.6）°;（4.9±5.5）°vs（6.5±4.4）°,差异有统计学意义;但相关前凸角及其改变与临床各评分及其改变无明确相关性.结论 单侧椎弓根螺钉固定TLIF术治疗老年单节段腰椎退行性滑脱安全有效,并发症低;在此基础上合并使用对侧TLFS术治疗老年双节段腰椎退行性滑脱患者,效果同样良好.Objective A retrospective study to evaluate clinical outcomes of aged patients conducted with unilateral in- strumented transforaminal lumbar interbody fusion （TLIF） for the lumbar degenerative spondylolisthesis with a mid-term follow-up, Methods From Jan. 2009 to Jun. 2012, there were a total of 29 elderly patients in this study, who suffered from symptomatic lumbar degenerative spondylolisthesis. Thirteen males and twenty-four females with a mean age of 73.1 years were enrolled, of which single-level patients were l6 and the others were double-levels. The average follow-up period was 39.4 ±9.8 months （range 24 to 54 months）. Operating time, blood loss, length of stay in hospital, and complications were recorded. Clinical outcomes were evaluated with Oswestry Disability Index （ODI）, visual analog scale （VAS） and Japanese Orthopedic Association scale （JOA）. The pre- and post- operation sagittal alignment （including lumbar lordosis angle （LL） and segment lordosis angle （SL） and fusion status were assessed by X-ray and 3-dimensional CT. Results The average operating time was 99.5 ± 32.3 minutes （ single-level： 86.3 ± 25.5 min, and double level： 115.8 ± 32.4 min ）, the average length of stay was 12.9 ± 3.7 days, and the blood loss was 210.3 ± 181.0 mL （ single-level： 195.0 ± 192.0 mL, and double level： 229.2±164.5 mL ）. The post-operation complication rate was 10.3%, and the fusion rate of slipping level was 89.7% at 24-months follow-up. The postoperative clinical outcomes and sagittal alignment angles were significantly different from the preoperative values. But there were no significant correlations between the changes of sagittal alignment angles and of clinical outcomes. Conclusion Unilateral instrumented TLIF is a safe and effective managerqent for single- level and double-levels lumbar degenerative spondylolisthesis in elderly patients, as less invasive with good clinical outcomes and a low complication rate.

关 键 词：腰椎退行性滑脱 单侧椎弓根螺钉固定 经椎间孔椎体间融合术 对侧关节突螺钉 疗效 老年 

分 类 号：R687.3[医药卫生—骨科学]