极外侧腰椎间融合术治疗轻度腰椎滑脱症

Extreme lateral interbody fusion combined with lateral plate versus bilateral pedicle screws for low-grade lum bar spondylolisthesis

[目的]比较极外侧腰椎间融合术(XLIF)侧方椎体螺钉固定与双侧椎弓钉固定治疗MeyerdingⅠ度和Ⅱ度腰椎滑脱症的临床疗效。[方法]回顾性分析2012年1月~2017年12月,应用XILF手术治疗MeyerdingⅠ度和Ⅱ度腰椎滑脱症患者54例。其中XLIF辅助侧方椎体螺钉固定(LF)30例,XLIF辅助双侧椎弓根螺钉固定(BPS)24例。比较两组患者的临床资料。[结果]LF组手术时间、切口总长度、术中失血量、术中透视次数和住院时间均显著优于BPS组(P<0.05)。随访12~23个月,平均(16.02±3.25)个月。随时间推移,两组患者疼痛明显减轻,功能改善良好。末次随访时两组患者的腰痛VAS和腿痛VAS评分均较术前显著减少(P<0.05),而JOA评分显著增加(P<0.05);相同时间点,两组的差异均无统计学意义(P<0.05)。影像评估方面,BPS组的滑脱复位率显著大于LF组(P<0.05)。两组患者术后DH、FH和LL均较术前显著增加,差异有统计学意义(P<0.05),末次随访时,BPS组DH大于LF组(P<0.05),其余相应时间点,两组间的差异均无统计学意义(P>0.05)。末次随访时,LF组融合率为80.00%,BPS组为83.33%,差异无统计学意义(P>0.05)。[结论]XLIF手术是治疗轻度腰椎滑脱症安全有效的微创术式。侧方椎体螺钉固定及双侧椎弓根螺钉固定的影像学及临床疗效相似。

[Objective]To compare the clinical outcomes of extreme lateral interbody fusion(XLIF)combined with unilater al lateral plate versus bilateral pedicle screws for Meyerding grade I and II lumbar spondylolisthesis.[Methods]A retrospective study was done on 54 patients who underwent XLIF for low-grade lumbar spondylolisthesis from January 2012 to December 2017.In term of internal fixation applied,30 patients had unilateral vertebral body fixed with lateral plate(the LF group),whereas the remaining 24 patients had posterior Wiltse approach for bilateral pedicle screws(the BPS group)subsequent to XLIF.The clinical documentations were compared between the two groups.[Results]The LF group proved significantly superior to the BPS regarding to operation time,total incision length,intraoperative blood loss,fluoroscopy frequency and hospital stay(P<0.05).As time went during the follow up period ranged from12 to 23 months with a mean of(16.02±3.25)months,the patients in both group achieved considerable pain relief and functional improvement.The VAS scores for low back pain and leg pain sig nificantly decreased,while the JOA scores significantly increased at the latest follow-up in contrast to those before operation in the both group(P<0.05),despite of the fact that no statistically significant differences were found between the two groups at any matching time point(P>0.05).With regard to radiographic assessment,the BPS group got significantly better reduction of the slippage than the LF group(P<0.05).The disc height,intervertebral foramen height and lumbar lordosis significantly increased at the latest follow up in both groups compared with those preoperatively(P<0.05),whereas no statistically significant differenc es were noted between the two group at any corresponding time point(P>0.05)except the disc height at the last follow up.To the latest follow up,the fusion rate was of 80.00%in the LF group,while 83.33%in the BPS group,which was not statistically significant(P>0.05).[Conclusion]The XLIF combined with lateral fixation or bilateral pedicle screws is a reliable minimally invasive technique for low-grade lumbar spondylolisthesis.No remarkable differences in radiologic and clini cal outcomes are found between the two internal fixation in this study.