小切口XLIF与后正中入路PLIF椎弓根螺钉固定治疗退变性腰椎侧凸

Clinical outcomes of XLIF through small incision approach versus PILF with open surgery for degenerative lumbar scoliosis

目的探讨小切口极外侧椎间融合extreme lateral interbody fusion，XLIF）经皮椎弓根螺钉固定治疗退变性腰椎侧凸的近期疗效。方法回顾性分析2011年12月至2013年6月应用小切口XLIF经皮椎弓根螺钉固定治疗的退变性腰椎侧凸患者（XLIF组）15例，男6例，女9例；年龄58-75岁，平均（68．27±5．70）岁；冠状面侧凸Cobb角14°-35°，平均22．20°±6．66°。同期采用后正中人路腰椎间融合（posterior lumber interbody fusion，PLIF）椎弓根螺钉固定治疗（PLIF组）23例，男9例，女14例；年龄49-73岁，平均（63．26±6．03）岁；冠状面侧凸Cobb角13°-36°，平均23．17°±6．95°。末次随访时评估侧凸Cobb角矫正率、疼痛视觉模拟评分（visual analogue scale，VAS）及腰椎功能日本骨科协会（Japanese Orthopaedic Association，JOA）评分。结果XLIF组手术时间（197．47±31．84）min，PLIF组（224．35±51．53）min，两组差异无统计学意义；XLIF组术中出血量（181．33±47．37）ml，PLIF组（576．52±227．89）ml，两组差异有统计学意义。XLIF组术中、术后均未采用输血治疗，PLIF组11例患者术中或术后采用输血治疗。两组术后Cobb角、疼痛VAS评分、腰椎功能JOA评分均较术前改善。38例获得随访，随访时间12-32个月，平均23个月。末次随访时侧凸Cobb角矫正率XLIF组56．90％±11．51％、PLIF组62．88％±8．28％，疼痛VAS改善率XLIF组87．97％±12．07％、PLIF组83．68％±12．33％，JOA评分改善率XLIF组84．00％±5．59％、PILF组84．79％±6．76％，两组比较差异均无统计学意义。结论对退变性腰椎侧凸，小切口XLIF经皮椎弓根螺钉固定与PLIF手术的近期疗效相当，但术中出血量更小。

Objective To investigate short-term clinical outcomes of XLIF through small incision approach combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis. Methods From December 2011 to June 2013, 15 patients with degenerative lumbar scoliosis were treated by XLIF combined with percutaneous pedicle screw fixation （XLIF group）. There were 6 males and 9 females, with an average age of 68.27±5.70 （ranging from 58 to 75） years old and Cobb angle of scoliosis 22.20°±6.66° （ranging from 14° to 35°）. Meanwhile, 23 patients were treated with posterior lumber inter-body fusion （PLIF） combined with pedicle screw fixation （PLIF group）. There were 9 males and 14 females, with an average age of 63.26±6.03 （ranging from 49 to 73） years old and Cobb angle of scoliosis 23.17°±6.95° （ranging from 13° to 36°）. The efficacy was assessed through correction rate of Cobb angle, VAS and lumbar JOA score at the time of the latest follow-up. Results The operation time was 224.35±51.53 rain in the PLIF group and 197.47±31.84 min in the XLIF group. No significant differences were found, but there was significantly difference in the intraoperative blood loss （PLIF group： 576.52±227.89 ml, XLIF group： 181.33±47.37 ml, t= -8.054, P 〈 0.001）. No patient accepted blood transfusion in the XLIF group, but in the PLIF group, 11 patients accepted blood transfusion. The Cobb angle, VAS and JOA score in two groups were improved compared with the preoperative. 38 patients were followed up for 12 to 32 months, with an average of 23 months. The correction rate of Cobb angle, VAS and JOA scores were 56.90%± 11.51%, 87.97%± 12.07%, 84.00%±5.59% in the XLIF group, and 62.88%±8.28%, 83.68%± 12.33%, 84.79%±6.76% in the PLIF group. No significant differences were found between the two groups （P 〉 0.05）. Conclusion Treatment of degenerative lumbar scoliosis with XLIF through small incision approach combined with percutaneous pedicle screw fixation is a kind of safe and effective minimally invasive spine surgery with small trauma and less bleeding, and the recent surgery efficacy was close to PILF.