后路中线腰椎椎间融合术与后路腰椎间融合治疗轻度退行性腰椎滑脱临床对比研究  

A comparative study of MIDLIF and PILF in the treatment of degenerative lumbar spondylolisthesis

作　　者：张希诺[1] 海涌[1] 关立[1] 刘玉增[1] 潘爱星 程云忠[1] 陶鲁铭 丁红涛 张苡齐 李越 陆鸿一 ZHANG Xi-nuo;HAI Yong;GUAN Li;LIU Yu-zeng;PAN Ai-xing;CHENG Yun-zhong;TAO Lu-ming;DING Hong-tao;ZHANG Yi-qi;LI Yue;LU Hong-yi(Department of Orthopedic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中国骨与关节杂志》2023年第1期12-21,共10页Chinese Journal of Bone and Joint

基　　金：北京市自然科学基金-海淀原始创新联合基金(21L2139)。

摘　　要：目的评估应用基于皮质骨轨迹(cortical bone trajectory,CBT)螺钉的后路中线腰椎椎间融合术(midline lumbar interbody fusion,MIDLIF)与传统后路腰椎间融合(posterior lumbar interbody fusion,PLIF)在退行性腰椎滑脱(degenerative spondylolisthesis,DS)中的治疗效果。方法回顾性分析2017年10月至2019年10月,应用MIDLIF技术和同组医师实行PLIF技术治疗DS患者共43例,其中男18例,女25例;年龄45~76岁,平均(61.81±5.63)岁。观察患者年龄、性别、随访时间、体质量指数(body mass index,BMI),术前合并糖尿病、高血压病、心脏病、骨密度(bone mineral density,BMD)、吸烟情况、手术时间、术中出血量和术后住院时间,以及手术前后腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)和骨盆入射角(pelvic incidence,PI)。PI与LL之差(pelvic incidence minus lumbar lordosismismatch,PI-LL);矢状面轴向距离(sagittal vertical axis,SVA)等影像学参数。滑脱参数包括滑脱百分比(slip percentage,SP)、滑脱角(slip angle,SA)和滑脱减少率(reduction rate,RR)。术后并发症包括椎间隙塌陷、螺钉松动和假关节形成。采用重复测量方差分析Oswestry功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分和腰部疼痛视觉模拟评分(visual analogue scale,VAS)。结果本组平均随访时间(35.63±8.14)个月,术前两组糖尿病、高血压病、心脏病和吸烟情况差异无统计学意义。平均骨密度值(-1.08±1.82)g/cm^(2),术中平均出血量(397.44±334.69)ml,平均手术时长(236.98±59.01)min,术后住院天数(16.21±3.97)天。CBT组术中出血量显著小于PS组,差异有统计学意义(P=0.011);CBT组手术时间显著小于PS组,差异有统计学意义(P=0.021);CBT组住院时间显著小于PS组,差异有统计学意义(P=0.027);术前和末次随访的脊柱骨盆参数LL、SS、SVA,末次随访PT、PI、PI-LL两组差异无统计学�Objective To analyze the application of midline lumbar interbody fusion(MIDLIF)and traditional posterior lumbar interbody fusion(PLIF)in the evaluation of the treatment effect of degenerative lumbar spondylolisthesis.Methods From October 2017 to October 2019,43 patients(18 males and 25 females,aged 45-76 years,mean age 61.81±5.63 years)with DS were treated with MIDLIF and PLIF.Observe patient age,gender,follow-up time,body mass index(BMI),preoperative diabetes,hypertension,heart disease,bone mineral density(BMD),smoking,operation time,intraoperative blood loss and postoperative hospital stay;as well as preoperative and postoperative lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT)and pelvic incidence(PI),pelvic incidence minus lumbar lordosismismatch(PI-LL),sagittal axial distance(SVA)and other imaging parameters.The slip parameters include slip percentage(SP),slip angle(SA)and slip reduction rate(RR).Postoperative complications included:intervertebral space collapse,screw loosening,and pseudoarthrosis formation;repeated measures analysis of variance was used to analyze the Oswestry Disability Index(ODI),Japanese Orthopaedic Association(JOA)score,and visual analogue scale(VAS)for lumbar pain.Results The average follow-up time of this group was(35.63±8.14)months,and there were no significant differences in preoperative diabetes,hypertension,heart disease and smoking between the two groups.The mean bone mineral density was(-1.08±1.82)g/cm^(2),the mean intraoperative blood loss was(397.44±334.69)ml,the mean operation time was(236.98±59.01)min,and the mean postoperative hospital stay was(16.21±3.97)days.The intraoperative blood loss in CBT group was significantly less than that in PS group,and the differences were statistically significant(P=0.011);the operation time in CBT group was significantly shorter than that in PS group,and the differences were statistically significant(P=0.021);the intraoperative hospital stay in CBT group was significantly shorter than that in PS group,and the differences were stat

关 键 词：内固定器 脊椎滑脱 腰椎 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]