改良经椎间孔入路及后路腰椎椎间融合术治疗中老年轻中度腰椎滑脱症疗效比较  

Comparative study on effectiveness of modified-transforaminal lumbar interbody fusion and posterior lumbar interbody fusion surgery in treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients

作　　者：杨智杰 刘渤[1] 蓝海洋 叶禾[1] 陈杰 夏辉强 张野 韩非 YANG Zhijie;LIU Bo;LAN Haiyang;YE He;CHEN Jie;XIA Huiqiang;ZHANG Ye;HAN Fei(Department of Orthopaedics,the 1st Affiliated Hospital of Chongqing Medical University,Chongqing Spine Surgical Center,Chongqing,400042,P.R.China)

机构地区：[1]重庆医科大学附属第一医院骨科重庆市脊柱外科中心,重庆400042

出　　处：《中国修复重建外科杂志》2020年第5期550-556,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较改良经椎间孔入路腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)与后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗中老年轻中度腰椎滑脱症的手术疗效。方法回顾分析2015年1月—2017年1月收治的符合选择标准的106例轻中度腰椎滑脱症(Meyerding分度≤Ⅱ度)患者临床资料,根据手术方式不同分为改良TLIF组(54例)及PLIF组(52例)。两组患者性别、年龄、病程、滑脱椎体、Meyerding分度及滑脱类型等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较两组术中出血量、手术时间、术后引流量、术后卧床时间、住院时间、并发症等围术期相关指标。术前及术后1周,1、6、12个月,末次随访时采用疼痛视觉模拟评分(VAS)和日本骨科协会(JOA)评分评价疼痛及功能改善情况,术前与末次随访时测量滑脱角与椎间隙高度评价椎体滑脱矫正情况,末次随访时根据Suk标准判定椎间融合情况。结果所有患者均获随访,随访时间A组25~36个月,平均32.7个月;B组24~38个月,平均33.3个月。改良TLIF组术中出血量、手术时间、术后引流量、术后卧床时间和住院时间均显著少于PLIF组(P<0.05)。两组患者术后各时间点VAS评分和JOA评分均较术前显著改善(P<0.05);术后1、6个月改良TLIF组VAS评分和JOA评分显著优于PLIF组(P<0.05)。两组患者末次随访时滑脱角及椎间隙高度均较术前显著改善(P<0.05);术前及末次随访时两组间滑脱角及椎间隙高度比较差异均无统计学意义(P>0.05)。末次随访时根据Suk标准,改良TLIF组椎间融合率为96.3%(52/54),PLIF组为98.1%(51/52),两组比较差异无统计学意义(χ2=0.000,P=1.000)。并发症:两组患者切口感染、肺部感染及术后1周内健侧神经损伤发生率比较差异均无统计学意义(P>0.05);改良TLIF组均未发生术中硬脊膜损伤及术后1周内患侧神经损伤,PLIF组分别发生4例(7.7%,P=0.054)和8例(15Objective To compare the effectiveness of modified transforaminal lumbar interbody fusion(modified-TLIF)and posterior lumbar interbody fusion(PLIF)for mild to moderate lumbar spondylolisthesis in middleaged and elderly patients.Methods The clinical data of 106 patients with mild to moderate lumbar spondylolisthesis(Meyerding classification≤Ⅱdegree)who met the selection criteria between January 2015 and January 2017 were retrospectively analysed.All patients were divided into modified-TLIF group(54 cases)and PLIF group(52 cases)according to the different surgical methods.There was no significant difference in preoperative clinical data of gender,age,disease duration,sliding vertebra,Meyerding grade,and slippage type between the two groups(P>0.05).The intraoperative blood loss,operation time,postoperative drainage volume,postoperative bed time,hospital stay,and complications of the two groups were recorded and compared.The improvement of pain and function were evaluated by the visual analogue scale(VAS)score and Japanese Orthopedic Association(JOA)score at preoperation,1 week,and 1,6,12 months after operation,and last follow-up,respectively.The effect of slip correction was evaluated by slip angle and intervertebral altitude at preoperation and last follow-up,and the effectiveness of fusion was evaluated according to Suk criteria.Results All patients were followed up,the modified-TLIF group was followed up 25-36 months(mean,32.7 months),the PLIF group was followed up 24-38 months(mean,33.3 months).The intraoperative blood loss,operation time,postoperative drainage volume,postoperative bed time,and hospital stay of the modified-TLIF group were significantly less than those of the PLIF group(P<0.05).The VAS score and JOA score of both groups were significantly improved at each time point after operation(P<0.05);the scores of the modified-TLIF group were significantly better than those of the PLIF group at 1 and 6 months after operation(P<0.05).The slip angle and intervertebral altitude of both groups were obvious

关 键 词：改良经椎间孔入路腰椎椎间融合术 后路腰椎椎间融合术 神经损伤 腰椎滑脱症 

分 类 号：R687.3[医药卫生—骨科学]