TLIF术式在治疗腰椎滑脱症中的临床应用研究

Study on the clinical application of TLIF operation in the treatment of lumbar spondylolisthesis

目的探讨TLIF术式治疗腰椎滑脱症的临床效果。方法 2013年1月~2017年6月间采用该手术方式对36例患者进行手术治疗。所有手术均由同一经验丰富的术者进行,术中首先置入椎弓根螺钉,然后采用TLIF方法进行减压,采用椎间融合器进行植骨融合。术前、术后分别记录视觉模拟评分法(VAS)以及Oswestry功能障碍指数(ODI);并根据术前、术后腰椎动力位X线片评价腰椎稳定性及腰椎椎间融合情况,必要时应用腰椎CT评价椎间融合情况。结果术后平均随访20(6~48)个月。患者术后1周VAS评分(3.09±0.66)分,术后6个月VAS评分(2.99±0.60)分及末次随访VAS评分(2.81±0.68)分较术前VAS评分(6.67±1.05)分显著降低(P<0.05);术后1周ODI指数(28.55±6.27)%,术后6个月ODI指数(26.97±6.48)%及末次随访ODI指数(26.73±5.50)%较术前ODI指数(74.32±9.39)%显著降低(P<0.05);术后1周、6个月及末次随访VAS评分、ODI指数差异无统计学意义(P>0.05);术后腰椎骨性融合时间平均8.4(3~12)个月,融合率100%。均未出现内固定物松动、断裂、移位等,均无神经损伤症状。结论 TLIF术式对于退变性和外伤性腰椎滑脱症的治疗,术后患者疼痛缓解明显,功能满意,复查时骨性融合率高,是一种临床疗效满意的手术方式。

Objective To investigate the clinical effect of TLIF operation in the treatment of lumbar spondylolisthesis. Methods From January 2013 to June 2017, 36 patients were given this surgical treatment. All surgeries were performed by the same experienced surgeon. The pediele screw was firstly placed in the operation. Then the TLIF method was used for decompression. An interbody fusion cage was used for bone graft fusion. Visual analogue scale （VAS） and Os- westry dysfunction index （ODI） were recorded preoperatively and postoperatively. According to the preoperative and postoperative lumbar dynamic X-ray films, the lumbar stability and lumbar interbody fusion were evaluated. Lumbar CT was used to evaluate the status of intervertebral fusion. Results The average follow-up period was 20 （6-48） months after surgery. The VAS score was （3.09±0.66） points after one week of surgery. The VAS score （2.99±0.60） at 6 months after surgery and the VAS score （2.81±0.68） at the final follow-up visit were significantly lower than the preoperative VAS score （6.67±1.05） （P〈0.05）; ODI index （28.55±6.27）% one week after surgery, the ODI index （26.97±6.48）% at 6 months after surgery and the ODI index （26.73±5.50）% at the final follow-up visit were significantly lower than the preoperative ODI index （74.32±9.39）% （P〈0.05）; there was no statistically significant difference in VAS score and ODI index at one week, six months after surgery and at final follow-up visit （P〉0.05）. Postoperative lumbar bony fusion time averaged 8.4（3-12） months and the fusion rate was 100%. No loosening, fractures, displacement of the internal fixations were observed. No nerve injury was observed. Conclusion For the TLIF operation in the treatment of degenerative and traumatic lumbar spondylolisthesis, the patients show obvious pain relief after surgery, satisfactory function, and a high rate of bone fusion at the time of re-examination. This is a surgical method with satisfactory clinical efficacy.