经关节突螺钉与椎弓根螺钉辅助斜外侧腰椎椎间融合术对单节段腰椎管狭窄症的疗效对比

Comparative study of percutaneous transfacet screw and pedicle screw in oblique lumbar interbody fusion for the treatment of single-level lumbar spinal stenosis

目的对比研究经关节突螺钉(TFS)和椎弓根螺钉(BPS)辅助斜外侧腰椎椎间融合术(OLIF)治疗单节段腰椎管狭窄症的效果。方法回顾性队列研究。回顾性分析2019年1月至2022年6月于北京积水潭医院脊柱外科行经TFS或BPS辅助OLIF手术治疗单节段腰椎管狭窄症的患者的临床资料。比较两组间影像学指标和临床指标。影像学指标包括:术前、术后即刻(术后5 d内)和术后1年随访时手术节段椎间隙高度和节段性前凸角,以及术后1年时椎间植骨融合情况。临床指标包括:手术时间、出血量、住院时间及并发症发生情况,以及术前和术后1年时Oswestry功能障碍指数(ODI)、腰痛及下肢痛视觉模拟评分(VAS)等。结果TFS辅助OLIF组男4例,女10例,年龄(61.0±11.2)岁,BPS辅助OLIF组男9例,女12例,年龄(60.9±6.7)岁。TFS组和BPS组术前椎间隙高度差异无统计学意义(P>0.05)。术后即刻椎间隙高度TFS组为(12.9±2.1)mm,1年随访时为(10.4±1.7)mm,BPS组术后即刻为(12.9±2.1)mm,1年随访时为(11.9±2.1)mm,两组间在术后1年随访时差异有统计学意义(P=0.037)。节段前凸角在术前、术后即刻、术后1年时组内变化及两组差异均无统计学意义(P>0.05)。术后1年时,TFS组的融合率为92.9%(13/14),BPS组为95.2%(20/21),两组间差异无统计学意义(P>0.05)。TFS组手术时间为(164.3±33.9)min,出血量为(74.3±46.9)ml,BPS组则分别为(191.7±31.8)min和(124.8±54.0)ml,TFS组均优于BPS组,差异均有统计学意义(均P<0.05)。术后1年两组ODI和VAS评分均较术前有明显改善,但两组间差异均无统计学意义(均P>0.05)。结论TFS辅助OLIF手术固定可有效恢复单节段腰椎管狭窄症患者椎间隙高度并缓解腰部及下肢疼痛。与BPS辅助OLIF手术相比,TFS组手术时间较短和出血量较少。

Objective To conduct a comparative study of radiological and clinical outcomes between percutaneous transfacet screw(TFS)and pedicle screw(BPS)in oblique lateral lumbar interbody fusion(OLIF)for single-level lumbar spinal stenosis.Methods A retrospective cohort study.Patients who underwent OLIF with TFS or BPS for the treatment of single-level lumbar spinal stenosis at Beijing Jishuitan Hospital from January 2019 to June 2022 were retrospectively analyzed.Radiological parameters and clinical indicators were compared between the two groups.Radiological parameters included preoperative,immediate postoperative(within 5 days),and 1-year postoperative measurements of disc height and segmental lordosis angle,as well as interbody fusion status at 1 year postoperatively.Clinical indicators included operative time,blood loss,length of hospital stay,complications,and Oswestry Disability Index(ODI),visual analogue scale(VAS)scores for back pain,and leg pain before and 1 year after surgery.Results Four male and 10 female patients with an average age of(61.0±11.2)years underwent OLIF with TFS,while 9 male and 12 female patients underwent OLIF with BPS,with a mean age of(60.9±6.7)years.There was no statistically significant difference in preoperative disc height between the TFS and BPS groups(P>0.05).The immediate postoperative disc height was(12.9±2.1)mm and it was(10.4±1.7)mm at 1-year follow-up in the TFS group;in the BPS group,it was(12.9±2.1)mm immediately postoperatively and(11.9±2.1)mm at 1-year follow-up;there was statistically significant difference between the two groups at 1-year follow-up(P=0.037).The segmental lordosis angle showed no significant differences within each group or between the two groups at preoperative,immediate postoperative,or 1-year postoperative follow-up(all P>0.05).At 1-year postoperative follow-up,the fusion rates was 92.9%(13/14)in the TFS group and 95.2%(20/21)in the BPS group,with no statistically significant difference between the two groups(P>0.05).The TFS group had a significantly shorter operative time and less blood loss compared to the BPS group[(164.3±33.9)minutes vs(191.7±31.8)minutes and(74.3±46.9)ml vs(124.8±54.0)ml,respectively](both P<0.05).Both groups showed significant improvement in ODI and VAS scores at 1 year postoperatively compared to those preoperatively,but with no statistically significant difference was found between the groups(both P>0.05).Conclusions OLIF with TFS fixation can effectively restore disc height and alleviate back and leg pain in patients with single-level lumbar spinal stenosis.Compared to the OLIF with BPS procedure,OLIF with TFS has shorter operative time and less blood loss.