微创经椎间孔椎间融合术治疗腰椎滑脱症的疗效分析  

The efficacy and complications of minimally invasive vs. the traditional open transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis

作　　者：吴爱悯[1] 胡志超 冯振华[1] 李肖斌[1] 徐晖[1] 王胜[1] 黄其杉[1] 毛方敏[1] 林焱[1] 王向阳[1] 倪文飞[1] Wu Aimin;Hu Zhichao;Feng Zhenhua;Li Xiaobing;Xu Hui;Wang Shen;Huang Qishan;Mao Fangmin;Lin Yan;Wang Xiangyang;Ni Wenfei(Department of Orthopaedic Surgery,Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院骨科医院脊柱外科,325027

出　　处：《中华骨科杂志》2018年第20期1230-1239,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目（81501933）;浙江省自然科学基金（LY17H060009）;浙江省卫生厅（2018KY129）;温州市领军型人才创新创业项目（RX2016004）;温州市科技局（Y20170389）

摘　　要：目的探讨微创经椎间孔椎体间融合术（transforaminal lumbar interbody fusion，TLIF）治疗腰椎滑脱症的临床疗效及其并发症分析。方法2010年1月至2015年6月期间142例单节段腰椎滑脱接受TLIF手术治疗的患者，按手术方式分为微创TLIF组（68例）和开放TLIF组（74例）。分别记录两组患者一般资料（年龄、性别、类型、滑移程度及滑脱节段）、手术时间、术中出血量、术后住院时间、腰部及下肢疼痛的视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI），并测量椎间隙后缘高度、节段前凸角、滑移复位程度，硬膜囊面积恢复情况等参数。结果两组患者基线资料统计分析显示年龄、性别比、滑移程度及手术节段分布的差异均无统计学意义，表明两组患者具有基线可比性。微创组和开放组分别有66例和71例随访至术后2年，25例和31例随访至术后5年。微创TLIF组术中出血量为（164．7±51．7）ml，明显低于开放TLIF组（239±69．3）ml（t=-7．237，P〈0．001）；术后住院时间为（5．9±1．5）d，也明显少于开放TLIF组（7．3±3．1）d（t=-3．607，P〈0．001）。微创组和开放组手术时间分别为（146．3±21．9）min和（152．0±20．4）min，差异无统计学意义。术后2年微创组腰部和下肢疼痛VAS评分、ODI分别为（1．76±1．16）分、（1．91±1．36）分和23．5％±7．3％，开放组分别为（1．73±1．10）分、（1．83±1．36）分和23．8％±6．7％；微创组椎间隙后缘高度、节段前凸角分别为（9．52±1．67）mm和12．11°±3．44°，开放组分别为（9．88±1．54）mm和12．98°±3．83°，与术前比较差异均有统计学意义，但两组间比较差异均无统计学意义。术后5年微创组腰部和下肢疼痛VAS评分、ODI分别为（1．73±1．21）分、（1．93±1．21）分和25．4％±6．8％，开放组分别为（Objective To investigate the clinical efficacy and complications of minimally invasive transforaminal lumbar-interbody fusion （TLIF） in the treatment of lumbar spondylolisthesis. Methods Total 142 patients with single level spondylolis-thesis who treated by TLIF from 2010.01 to 2015.06 were included in this study, with 68 cases in minimally invasive TLIF （MIS- TLIF） group and 74 cases in traditional open TLIF group. The general information （age, gender, isthmic or degenerative type, per-centage of slip degree, levels）, operative time, blood loss, length of postoperative hospital stay, Visual Analogue Scale （VAS） of low-back pain and leg pain, and Oswestry Disability Index （ODI） were recorded and collected. The posterior height of the interverte- bralpace and segmental lordosis, reduction of spondylolisthesis and cross-sectional area of spinal canal were measured. Results There was no statistically significant difference between the two groups in age, gender ratio, percentage of slip degree, and sur- gicallevels distribution. Total of 66 cases in MIS-TLIF group and 71 cases in Open TLIF group finished 2 years follow up, and 25 cases in MIS-TLIF group and 31 cases in Open TLIF group finished 5 years follow up. The blood loss of the MIS-TLIF group was 164.7±51.7 ml, significantly lower than the open TLIF group of 239±69.3 ml（P〈0.001）. The length of postoperative hospital stay was 5.9±1.5 days in MIS-TLIF group, significantly shorter than the open TLIF group of 7.3±3.1 days（P〈0.001）. The operative time of MIS-TLIF and Open TLIF was 146.3±21.9 mins, 152.0±20.4 mins, respectively, and no significant differ-ence was found between them. The VAS ofbaek pain, leg pain, ODI in MIS-TLIF group was 1.76±1.16, 1.91±1.36 and 23.5±7.3 at 2 years follow up, and in Open TLIF was 1.73±1.10, 1.83±1.36 and 23.8±6.7, respectively, all of them were significant-ly different to pre-operation, however, no significant difference was found between two groups. The VAS of back pain, leg pain, ODI in

关 键 词：腰椎 脊椎滑脱 外科手术 微创性 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]