Wiltse入路微创经椎间孔腰椎间融合术治疗65例腰椎滑脱患者的临床疗效

Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion(TLIF) through Wiltse approach for the treatment of 65 patients with lumbar spondylolisthesis

目的探讨Wiltse入路微创经椎间孔腰椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎滑脱患者的临床疗效。方法选择我院2013年4月~2018年3月收治的65例患者随机分为对照组(n=33)和观察组(n=32)。两组均进行常规基础治疗,对照组给予传统腰椎后正中入路MIS-TLIF治疗,观察组给予Wiltse入路MIS-TLIF治疗。观察比较两组手术时间、术中出血量、住院时间、术中射线暴露时间,比较患者腰痛、腿痛视觉模拟评分(Visual analogue scale,VAS)、腰痛(Japanese Orthopaedics Association,JOA)评分、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、SF-36(the MOS item short from health survey)评分及不良反应发生情况。结果术后观察组手术时间、术中出血量、住院时间、术中射线暴露时间明显低于对照组(P<0.05)。两组腰痛、腿痛VAS评分较术前均显著降低,而JOA评分显著升高(P<0.05);观察组腰痛、腿痛VAS评分低于对照组,JOA评分高于对照组(t=-8.830,P=0.000;t=-7.705,P=0.000;t=2.061,P=0.044)。两组ODI指数较术前均显著降低(P<0.05),观察组ODI指数低于对照组(t=-3.815,P=0.000)。两组SF-36评分均显著升高(P<0.05),观察组SF-36评分显著高于对照组(t=2.095,P=0.040)。观察组并发症发生率为12.50%,显著低于对照组36.36%(χ^2=4.735,P=0.030)。结论 Wiltse入路MIS-TLIF治疗腰椎临床疗效显著,可有效改善腰椎功能,缩短手术及住院时间,减少出血量及术后疼痛,提高患者生活质量,值得推广应用。

Objective To investigate the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) through Wiltse approach in the treatment of lumbar spondylolisthesis. Methods Sixty-five patients admitted in our hospital from April 2013 to March 2018 were randomly divided into control group(n=33) and observation group(n=32). Routine basic treatment was performed in both groups. The control group was treated with traditional lumbar MIS-TLIF by posterior approach. The observation group was treated with MIS-TLIF by Wiltse approach. The operation time, intraoperative blood loss, hospital stay, intraoperative radiation exposure time between two groups were observed and compared. The low back pain, visual analogue scale(VAS), Japanese Orthopaedics Association(JOA), Oswestry Disability Index(ODI), SF-36(the MOS item short from health survey) scores and adverse reactions between two groups were compared. Results After operation, the operation time, intraoperative blood loss, hospital stay, and intraoperative radiation exposure time in the observation group were significantly lower than those in the control group(P<0.05). The VAS scores of low back pain and leg pain were significantly lower in the two groups than those in the preoperative period, while the JOA scores were significantly higher(P<0.05). The VAS scores of low back pain and leg pain were lower in the observation group than those in the control group, and the JOA scores were higher than those in the control group(t=-8.830, P=0.000;t=-7.705, P=0.000;t=2.061, P=0.044). The ODI index of the two groups was significantly lower than that before surgery(P<0.05). The ODI index of the observation group was lower than that of the control group(t=-3.815, P=0.000). The SF-36 scores of both groups were significantly increased(P<0.05), and the SF-36 scores of the observation group were significantly higher than those in the control group(t=2.095, P=0.040). The incidence of adverse reactions in the observation group was 12.50%, which was significantly lower than 36.36% in the control group(χ^2=4.735, P=0.030). Conclusion MIS-TLIF by Wiltse approach has a significant clinical effect in the treatment of lumbar vertebrae, which can effectively improve lumbar function, shorten the time of surgery and hospitalization, reduce the amount of bleeding and postoperative pain, and improve the quality of life of patients. It is worthy of popularization and application.