微创经椎间孔腰椎体间融合术与传统开放手术对退变性腰椎滑脱症腰椎-骨盆矢状位参数的不同影响

The different impact on saggital spinopelvic alignment in degenerative spondylolisthesis between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion

目的：比较微创经椎间孔腰椎体间融合术（transforaminal lumbar interbody fusion，TLIF）与传统开放后路腰椎体间融合术（posterior lumbar interbody fusion，PLIF）治疗退变性腰椎滑脱症对腰椎-骨盆矢状位参数的不同影响。方法：回顾性分析比较2010年6月~2013年6月符合纳入标准的L4单节段退变性腰椎滑脱症48例患者的临床资料，其中23例采用传统开放PLIF治疗（开放组），25例采用微创Quadrant系统下TLIF治疗（微创组）。在包含双侧股骨头的站立位腰椎侧位X线片上，测量微创组与开放组术前及末次随访的滑脱度（SP）、腰椎前凸角（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰骶角（LSA）、滑脱角（SA）及L1铅垂线与S1距离（LASD）参数变化，采用相关分析分析各参数间的相关性。结果：开放组的滑脱复位率（ΔSP）为（67.42±33.80）%，明显高于微创组的（36.59±50.68）%（P〈0.05）。微创组末次随访时的LL为43.03°±14.07°、SA为3.12°±4.02°，均明显低于术前的46.53°±15.72°、6.10°±5.64°（P〈0.05）。开放组的ΔSA为2.53°±6.63°，明显高于微创组的-2.98°±5.42°（P〈0.05）。开放组的ΔLASD为-4.10±14.53mm，明显低于微创组的3.48±9.01mm（P〈0.05）。术前SP与LASD、ΔSA与ΔLL具有正相关关系，ΔLL与ΔPT具有负相关关系。结论：对于退变性腰椎滑脱，微创TLIF和开放PLIF都能明显地使滑脱椎体复位，但开放PLIF的滑脱复位率较高。微创TLIF可明显减小LL、SA，导致融合节段相对后凸。开放PLIF可明显减小LASD，更有助于改善脊柱-骨盆矢状位力线平衡。

Objectives： To compare the different impact on saggital spinopelvic alignment in degenerative spondylolisthesis between minimally invasive transforaminal lumbar interbody fusion（TLIF） and conventional open posterior lumbar interbody fusion（PLIF）. Methods： From June 2010 to June 2013, 48 patients with L4 single segmental degenerative spondylolisthesis met the inclusion criteria underwent traditional open PLIF in 23 cases（OPEN group） and minimally invasive TLIF in 25 cases（MIS group）, and the clinical data were analyzed retrospectively. The following data of preoperation and final follow-up were compared between the two groups on the standing lateral lumbar X-ray which containing bilateral femoral heads： slip percentage（SP）, lumbar lordosis（LL）, pelvic incidence（PI）, pelvic tilt（PT）, sacral slop（SS）, lumbosacral angle（LSA）, slip angle（SA） and the L1 axis and S1 distance（LASD）. The correlation between the parameters was analyzed using correlate analysis. Results： The rate of slip reduction（ΔSP） in OPEN group was （67.42±33.80）%, which was significantly higher than that in MIS group （36.59±50.68）%（P〈0.05）. The LL at final follow-up was 43.03°±14.07°, SA was 3.12°±4.02°, which were both significantly lower than preoperative ones（46.53°±15.72° and 6.10°±5.64° respectively） in MIS group（P〈0.05）. ΔSA in OPEN group was 2.53°±6.63°, which was significantly higher than that in MIS group（-2.98°±5.42°）（P〈0.05）. ΔLASD in OPEN group was -4.10°±14.53°, which was significantly lower than that in MIS group（3.48°±9.01°）（P〈0.05）. There were positive correlations between preoperative SP and LASD, ΔSA and ΔLL, and negative correlation between ΔLL and ΔPT. Conclusions： For degenerative spondylolisthesis, minimally invasive TLIF and open PLIF all can make a significant reduction to slippage vertebral, but open PLIF has a higher rate of slip reduction. Minimally invasive TLIF significant reduce LL and SA, resulting in relative kyphosis on fusion segment. Open PLIF significant reduce LASD, is more conductive to improve sagittal spinopelvic balance.