横突定位法与人字嵴顶点法MIS-TLIF对腰椎退行性疾病治疗效果的影像学评价

Effect comparison between transverse locating method and herringbone vertex method MIS-TLIF based on imaging evaluation in the treatment of lumbar degenerative diseases

目的基于影像学评价横突定位法与人字嵴顶点法微创经椎间孔椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎退行性疾病的临床效果。方法:纳入2015年2月~2016年6月收治的86例L4~S1节段的腰椎退行性疾病手术患者,均采用MIS-TLIF 治疗,随机均分为观察组与对照组各43例,对照组患者采用人字嵴顶点法置钉,观察组患者采用横突定位法置钉,记录两组患者手术相关指标,随访2年以上,采用Rao分级评价螺钉位置,评价关节突关节破坏分级,比较椎弓根螺钉水平角(TSA)与矢状角(SSA)。结果末次随访时,观察组Rao分级、关节突关节破坏分级均优于对照组(P<0.05),L4、L5椎弓根螺钉的TSA角显著大于对照组(P<0.05),上述差异均有统计学意义。两组各节段椎弓根螺钉SSA差异均无统计学意义(P>0.05)。结论 MIS-TLIF 横突定位法置钉较人字嵴顶点法置钉准确率较高,对邻近节段关节突关节破坏程度低,手术时间更短,但L4、L5节段置钉需适当增大TSA。

Objective To compare the clinical effect between transverse locating method and herringbone vertex method minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) based on imaging evaluation in the treatment of lumbar degenerative diseases. Methods Eight-six patients with lumbar degenerative diseases (surgical segment L4~S1) admitted to our hospital from February 2015 to June 2016 were selected in the study. All patients were treated with MIS- TLIF and randomly divided into the observation group and the control group, with 43 cases in each group. The patients in the control group were treated with the herringbone apex method. The patients in the observation group were treated by the transverse process. The surgical related indicators of the two groups were recorded. After 2 years of follow-up, the screw position was evaluated by Rao classification. The classification of articular joint destruction was evaluated and the horizontal angle(TSA) and sagittal angle (SSA) of pedicle screws were compared. Results At the last follow-up, Rao grade and facet joint damage grade in the observation group were better than those in the control group (P<0.05). TSA angle of L4 and L5 pedicle screw in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference in SSA of pedicle screw between the two groups (P>0.05). Conclusion The MIS-TLIF transverse positioning method is more accurate than the herringbone apex method. The degree of destruction of adjacent joints and joints is low, and the operation time is shorter, but the L4 and L5 segments need to be properly increased TSA.