可扩张通道系统下微创经椎间孔椎体间融合术对退行性腰椎滑脱症患者脊柱-骨盆矢状面形态和腰背功能的影响  

Effects of minimally invasive spine surgery-transforaminal lumbar interbody fusion under the expandable channel system on the spinal-pelvic sagittal morphology and lumbodorsal function of patients with degenerative lumbar spondylolisthesis

作　　者：王玉辉 杜贵娟 马虎升 马涛 WANG Yuhui;DU Guijuan;MA Husheng;MA Tao(Department of Spinal Surgery,Luoyang Orthopedic Hospital of Henan Province/Henan Orthopaedic Hospital,Zhengzhou 450000,Henan Province,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)脊柱外一科,河南郑州450000

出　　处：《新乡医学院学报》2025年第2期112-116,122,共6页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20191058)。

摘　　要：目的探讨可扩张通道系统下微创经椎间孔椎体间融合术(MISS-TLIF)对退行性腰椎滑脱症(DLS)患者脊柱-骨盆矢状面形态、腰背功能的影响。方法选择2019年7月至2022年3月于河南省洛阳正骨医院(河南省骨科医院)接受手术治疗的90例DLS患者为研究对象,根据手术方式将患者分为对照组(n=51)和观察组(n=39)。对照组患者接受传统开放手术;观察组患者接受可扩张通道系统下MISS-TLIF。比较2组患者的手术时间、术中失血量、术中透视数、自主下床活动时间。于术前、术后6个月,采用数字分级法(NRS)评估患者的疼痛改善情况,Oswestry功能障碍指数(ODI)评估腰背功能障碍程度,日本骨科学会腰痛评价量表(JOA)评估腰痛程度;拍摄脊柱全长侧位片或腰椎侧位X线片并测量骨盆入射角(PI)、骨盆倾斜角(PT)、腰椎前凸角(LL)、骶骨倾斜角(SS)、椎间隙高度(DH)、手术节段椎间隙后缘高度(PDH)、手术节段椎间隙前缘高度(ADH)等腰骶部矢状位平衡参数。观察并记录2组患者围手术期是否出现融合器位置不佳、切口感染、硬膜囊撕裂等并发症。结果观察组患者的手术时间、术中透视次数显著多于对照组,术中失血量显著少于对照组,自主下床活动时间显著早于对照组(P<0.05)。术前,观察组与对照组患者的NRS、ODI、JOA比较差异无统计学意义(P>0.05);术后6个月,2组患者的NRS、ODI显著低于术前,JOA显著高于术前(P<0.05);术后6个月,观察组患者的NRS、ODI显著低于对照组,JOA显著高于对照组(P<0.05)。术前,观察组与对照组患者的PT、LL、PI、SS、DH、ADH、PDH比较差异无统计学意义(P>0.05);术后6个月,2组患者的PT、LL显著低于术前,DH、ADH显著高于术前(P<0.05);术后6个月,观察组患者的PT、LL显著低于对照组,DH、ADH显著高于对照组(P<0.05)。对照组和观察组患者的并发症发生率分别为19.61%(10/51)、5.13%(2/39);观察患者的并发症发�Objective To investigate the effects of minimally invasive spine surgery-transforaminal lumbar interbody fusion(MISS-TLIF)under the expandable channel system on the spinal-pelvic sagittal morphology and lumbodorsal function of patients with degenerative lumbar spondylolisthesis(DLS).Methods A total of 90 patients with DLS who underwent surgical treatment at Luoyang Orthopedic Hospital from July 2019 to March 2022 were selected as the study subjects,and the patients were divided into the control group(n=51)and the observation group(n=39)according to the surgical methods.The patients in the control group underwent conventional open surgery;while those in the observation group received MISS-TLIF under the expandable channel system.The surgical time,intraoperative blood loss,intraoperative fluoroscopy number,and independent mobilization time of patients were compared between the two groups.Before surgery and 6 months after surgery,the pain improvement of patients was evaluated by using the numerical rating scale(NRS),the severity of lumbodorsal function impairment was evaluated by using the Oswestry disability index(ODI),and the severity of low back pain was evaluated by using the Japanese Orthopaedic Association(JOA)scores.The pelvic incidence(PI),pelvic tilt(PT),lumbar lordosis(LL),sacral slope(SS),disc height(DH),posterior disc height(PDH)of the surgical segment intervertebral space,and anterior disc height(ADH)of the surgical segment intervertebral space in the lumbar-sacral region of patients in the two groups were measured on the full-length lateral radiographs of the spine or lumbar lateral X-rays.The complications including poor fusion device position,incision infection,and dural sac tear during the perioperative period of patients in the two groups were observed and recorded.Results The surgical time and intraoperative fluoroscopy number of patients in the observation group were significantly higher than those in the control group,the intraoperative blood loss was significantly lower than that in the control

关 键 词：退行性腰椎滑脱症 可扩张通道系统 微创经椎间孔椎体间融合术 脊柱-骨盆矢状面形态 腰背功能 

分 类 号：R687.3[医药卫生—骨科学]