Wiltse入路微创经椎间孔腰椎间融合术治疗腰椎滑脱症  

Wiltse Approach and Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis

作　　者：徐彬[1] 徐峰 李涛[1] 谭林英 胡昊 秦佳军 齐凤宇 

机构地区：[1]湖北中医药大学针炙骨伤学院,湖北武汉430065 [2]解放军武汉总医院骨科

出　　处：《华南国防医学杂志》2017年第10期647-652,共6页Military Medical Journal of South China

基　　金：湖北省自然科学基金项目(2014CFB473)

摘　　要：目的探讨Wiltse入路微创经椎间孔腰椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎滑脱症的近期临床疗效。方法选择2015-05/2016-05月收治的46例单节段Meyerding分级为Ⅰ~Ⅱ度的腰椎滑脱症患者,其中男24例,女22例,年龄25~78(54.1±10.2)岁,病程3~48个月。采用Wiltse入路MIS-TLIF治疗21例(微创组),传统后正中入路开放手术25例(开放组)。比较两组患者的手术时间、术中出血量、术中射线暴露时间、住院时间。随访并记录术前,术后3 d、3个月、1年时患者的腰痛、腿痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI)及两组手术前后的滑脱角、滑脱率及椎间隙高度等指标来评估两组手术的疗效。结果 46例患者均获得随访12~24(18.3±9.2)个月。两组在手术时间方面比较差异无统计学意义(P>0.05);在出血量、住院时间方面微创组明显低于开放组(P<0.05),在术中射线暴露时间方面,开放组低于微创组(P<0.05)。两组术后不同时期的VAS、ODI评分与术前相比差异均有统计学意义(P<0.05)。微创组术后3 d腰痛VAS评分明显低于开放组(P<0.05);在术前、术后滑脱角、滑脱率及椎间隙高度等结果比较,两组组内比较差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。结论 Wiltse入路MIS-TLIF治疗腰椎滑脱症近期疗效显著,手术创伤较小、有利于术后恢复。Objective To explore the recent clinical efficacy of Wiltse approach and minimally invasive transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis.Methods A total of 46 patients with lumbar spondylolisthesis which Meyerding grade wereⅠ-Ⅱ degree between May 2015 to May 2016 in authors＇ hospital were assigned to Wiltse approach and minimally invasive group（n=21）and open group（n=25）,including 24 males and 22 females,aged 25 to 78 years[（54.1±10.2）years].And the courses of disease were 3 to 48 months.The differences of the operation time,intraoperative blood loss,intraoperative radiation exposure time and hospital stay were compared.The visual analogue scale（VAS）,Oswestry disability index（ODI）and the slip angle,slip rate,intervertebral height and other indicators were used to assess the efficacy of before and after 3 days,3 months and 1 year treatment.Results All 46 patients were followed up for 12-24 months,with an average of（18.3±9.2）months.There was no significant difference in the operation time between two groups（P0.05）.The intraoperative blood loss and hospital stay in minimally invasive group were significantly lower than those in the open group（P0.05）.The intraoperative radiation exposure time in the open group was lower than that in the minimally invasive group（P0.05）.The VAS and ODI scores of two groups were significantly different at various postoperative time points when compared with the preoperation（P 0.05）.The VAS score of lumbago in 3 days after operation was significantly lower in minimally invasive group than that in open group（P0.05）.The slip angles,slip rates and intervertebral height results of two groups were significantly different between preoperation and postoperation（P0.05）,but no significant difference between two groups.Conclusion The recent efficacy of Wiltse approach and minimally invasive transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis is significant,and it has less

关 键 词：腰椎滑脱 Wiltse入路 Vista通道系统 微创经椎间孔腰椎间隔合术 

分 类 号：R681.53[医药卫生—骨科学]