显微内镜辅助下微创经椎间孔腰椎椎体间融合术治疗老年退变性腰椎滑脱症的疗效观察  

Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion assisted with microscope in treatment of senile degenerative spondylolisthesis

作　　者：熊尚文 牛朋彦[1] 韩志红 岳瑞雪 王志强[1] XIONG Shangwen;NIU Pengyan;HAN Zhihong;YUE Ruixue;WANG Zhiqiang(Department of Spine and Bone Tumor,The First Hospital of Handan City,Hebei,Handan 056002,China)

机构地区：[1]河北省邯郸市第一医院脊柱与骨肿瘤一科,056002

出　　处：《临床外科杂志》2023年第12期1191-1195,共5页Journal of Clinical Surgery

基　　金：河北省邯郸市科学技术研究与发展计划项目(21422083068)。

摘　　要：目的探讨显微内镜辅助下微创经椎间孔腰椎椎体间融合术(MIS⁃TLIF)治疗老年退变性腰椎滑脱症的临床疗效。方法2020年1月~2021年3月收治的老年退变性腰椎滑脱症病人100例,根据手术方法分为MIS⁃TLIF组和经椎间孔腰椎椎体间融合(TLIF)组,均为50例。比较两组围手术期指标、手术前后的疼痛视觉模拟评分(VAS)、日本骨科协会评估治疗分数(JOA)和功能障碍评分(ODI)、术后植骨融合率及并发症发生情况。结果MIS⁃TLIF组手术时间、术中出血量、切口长度、术后引流量和住院时间分别为(167.5±54.2)分钟、(173.8±47.1)ml、(3.5±0.7)cm、(69.6±16.3)ml、(8.3±2.7)天,TLIF组分别为(136.3±38.9)分钟,(281.0±50.3)ml、(10.0±2.1)cm、(148.4±28.2)ml、(11.2±3.1)天,两组比较差异有统计学意义(P<0.05)。MIS⁃TLIF组术后1个月VAS、JOA和ODI评分分别为(2.17±0.62)分、(21.72±3.14)分、(13.22±2.43)分;TLIF组分别为(3.24±1.06)分、(17.06±2.85)分、(16.83±2.87)分,两组比较差异有统计学意义(P<0.05)。两组病人术后12个月时植骨融合率比较差异无统计学意义(P>0.05)。MIS⁃TLIF组和TLIF组术后并发症发生率分别为8.00%和24.00%,两组比较差异有统计学意义(P<0.05)。结论显微内镜辅助下MIS⁃TLIF治疗创伤小、恢复快、术后并发症少。Objective To investigate the clinical efficacy of endoscopic assisted minimally invasive trans foraminal lumbar interbody fusion(MIS⁃TLIF)and traditional open TLIF in the treatment of senile degenerative spondylolisthesis.Methods From January 2020 to March 2021,100 elderly patients with degenerative spondylolisthesis were selected and divided into MIS⁃TLIF group and TLIF group according to the surgical method,with 50 cases in each group.The preoperative and postoperative VAS,Japanese 0rthopedic Association score(JOA)and Oswestry disability index(ODI),and the rate of interbody fusion and the incidence of complications were compared and analyzed between the two groups.Results In MIS⁃TLIF group,the operative time,intraoperative blood loss,incision length,postoperative drainage volume and hospital stay were(167.5±54.2)minutes,(173.8±47.1)ml,(3.5±0.7)cm,(69.6±16.3)ml,and(8.3±2.7)days,respectively.In the TLIF group,it was(136.3±38.9)minutes,(281.0±50.3)ml,(10.0±2.1)cm,(148.4±28.2)ml,and(11.2±3.1)days,respectively.The difference between the two groups was statistically significant(P<0.05).The VAS,JOA and ODI scores of MIS⁃TLIF group were(2.17±0.62)points,(21.72±3.14)points and(13.22±2.43)points,respectively.The results in TLIF group were(3.24±1.06)points,(17.06±2.85)points and(16.83±2.87)points,respectively,and there was statistical significance between the two groups(P<0.05).There was no significant difference in the rate of interbody fusion between the two groups at 12 months after operation(P>0.05).The incidence of postoperative complications in MIS⁃TLIF group(8.00%)was significantly lower than that in TLIF group(24.00%,P<0.05).Conclusion MIS⁃TLIF assisted by endoscope has the advantages of less trauma,faster recovery and less postoperative complications,and the short⁃term curative effect is more satisfactory than TLIF.

关 键 词：显微内镜 微创 经椎间孔腰椎椎体间融合术 退变性腰椎滑脱症 疗效 

分 类 号：R687.3[医药卫生—骨科学]