微创经椎间孔入路椎间融合术治疗腰椎滑脱症

Minimally invasive transforaminal interbody fusion in the treatment of lumbar spondylolisthesis

目的探讨微创经椎间孔入路椎间融合术(MIS-TLIF)治疗腰椎滑脱症的临床疗效。方法采用双侧Spotlight管状通道MIS-TLIF治疗36例单节段腰椎滑脱症患者。记录手术情况及术后并发症发生情况。术后1、3个月及末次随访时记录腰部及下肢疼痛VAS评分、椎间隙高度以及ODI。末次随访时采用改良MacNab标准评价手术疗效。结果手术时间130~200(162.54±25.98)min,术中出血量170~240(209.72±29.76)ml,卧床时间2~4(2.87±0.78)d,住院时间6~10(8.56±1.87)d,术后引流量70~120(92.13±18.67)ml。患者均获得随访,时间16~24(20.13±1.87)个月。患者均无神经损伤加重、内固定断裂等严重并发症发生。术后1、3个月及末次随访时,ODI、腰部及下肢VAS评分均低于术前(P<0.05),椎间隙高度均高于术前(P<0.05)。末次随访时,采用改良MacNab标准评价手术疗效,优良率为94.44%(34/36)。结论双侧Spotlight管状通道MIS-TLIF治疗腰椎滑脱症能显著改善其腰腿痛症状及功能障碍,手术创伤小,并发症少,疗效满意。

Objective To investigate the clinical effect of minimally invasive transforaminal interbody fusion(MIS-TLIF)in the treatment of lumbar spondylolisthesis.Methods Thirty-six patients with single-segment lumbar spondylolisthesis were treated with MIS-TLIF.The surgery situation and postoperative complications were recorded.The visual analogue scores(VAS)of lumbar and lower extremity,intervertebral space height and Oswestry dysfunction index(ODI)were evaluated at 1,3 months and the last follow-up.The operation effect was evaluated by modified MacNab criteria at the last follow-up.Results The operation time was 130~200(162.54±25.98)min,the intraoperative blood loss was 170~240(209.72±29.76)ml,time in bed was 2~4(2.87±0.78)d,hospitalization time was 6~10(8.56±1.87)d,postoperative drainage volume was 70~120(92.13±18.67)ml.All patients were followed up for 16~24(20.13±1.87)months.No severe complications such as nerve injures aggravation and internal fixation fracture were found in all patitents.The ODI,waist and lower limb VAS at 1,3 months after surgery and the last follow-up were all significantly decreased than before surgery(P<0.05),and the height of the intervertebral space was higher than before surgery(P<0.05).The excellent and good rate of modified MacNab standard evaluation was 94.44%(34/36)at the last follow-up.Conclusions MIS-TLIF through bilateral tubellar Spotlight channel in the treatment of lumbar spondylolisthesis can significantly improve the symptoms and dysfunction of low back pain,with less trauma,few complications,the curative effect is satisfactory.