改良经椎间孔腰椎椎体间融合术治疗腰椎滑脱症的中远期疗效观察

Middle and long-term clinical efficacy of modified transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesis

目的观察改良经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎滑脱症的中远期临床疗效。方法回顾性分析采用改良TLIF治疗的38例单节段腰椎滑脱症患者的临床资料,观察手术时间、术中失血量、术中硬膜囊及神经根损伤风险、术后复位情况和中远期腰椎融合情况,记录术前、术后1个月、术后1年和末次随访时(术后3年及以上)的疼痛视觉模拟评分法(VAS)评分、日本骨科学会(JOA)评分,评价患者的临床疗效。结果38例患者均顺利完成手术,术中未发生神经根及硬膜囊损伤,手术时间为(157.1±35.7)min,术中出血量为(318.5±76.7)mL;患者均获得随访,随访时间3~7年,平均4.7年;术后1个月、术后1年和末次随访时,患者腰腿痛VAS评分均低于术前,JOA评分均高于术前,差异有统计学意义(P<0.05);38例患者滑脱椎体复位良好,椎间均达到骨性融合。结论采用改良TLIF治疗腰椎滑脱症能有效降低硬膜囊和神经根损伤风险,具有手术时间短、出血少及复位良好的优势,中远期临床疗效确切。

Objective To observe middle and long-term clinical efficacy of modified transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar spondylolisthesis.Methods The clinical data of 38 patients with single segmental lumbar spondylolisthesis treated by modified TLIF was retrospectively analyzed.Duration of surgery,intraoperative blood loss,risk of intraoperative dural sac and nerve root injury,postoperative reduction and middle and long-term lumbar fusion were observed.The clinical efficacy was evaluated by Visual Analogue Scale(VAS)score and Japanese Orthopedics Association(JOA)score before operation,at one month and one year after surgery and at the time point of final follow-up(3 years and above after operation).Results All the 38 patients successfully completed the surgeries,without nerve root and dural sac injury.Average operative time was(157.1±35.7)min,and average intraoperative blood loss was(318.5±76.7)mL.All patients were followed up for 3 to 7 years,with an average of 4.7 years.VAS score of postoperative lumbar and leg pain was lower,and JOA score was significantly higher than that before operation,and the differences were statistically significant(P<0.05).All the 38 patients with spondylolisthesis had good reduction and bone fusion.Conclusion The modified TLIF operation for lumbar spondylolisthesis can effectively reduce the risk of dural sac and nerve root injury,and has the advantages of shorter operation time,less bleeding and good reduction.