不同入路MIS-TLIF治疗退变性腰椎滑脱症的疗效及其对血清TGF-β1、RAGE表达的影响

Clinical outcome of MIS-TLIF by different approaches for the treatment of degenerative lumbar spondylolisthesis and their effects on the expression of serum TGF-β1 and RAGE

目的评估两种不同入路微创经椎间孔腰椎椎体间融合术(MIS-TLIF)治疗单节段退变性腰椎滑脱症(DLS)的疗效,探讨两种术式对血清转化生长因子(TGF)-β1和晚期糖基化终产物受体(RAGE)表达的影响。方法选取2014年3月—2018年12月重庆市璧山区人民医院收治的70例单节段DLS患者,均采用MIS-TLIF手术治疗,根据手术入路的不同分为两组,其中A组行Wiltse入路,B组行正中入路,每组各35例。结果A组切口长度、住院时间、术中出血量少于B组,手术时间长于B组,术后1个月视觉模拟量表(VAS)评分和日本骨科学会(JOA)评分优于B组,两组比较,差异有统计学意义(P<0.05)。患者术后3 d、7 d血清TGF-β1和RAGE表达水平,术后1、3个月VAS评分、JOA评分及腰椎前凸角、椎间隙前凸角、椎间隙高度均较术前改善(P<0.05)。A组、B组在并发症发生率(9%vs 11%)、末次随访椎间融合率[(92.5±3.8)%vs(90.9±4.0)%]方面比较,差异无统计学意义(P>0.05)。结论MIS-TLIF治疗单节段DLS能够改善患者术后血清TGF-β1、RAGE表达水平,缓解疼痛症状,恢复腰椎生理曲度和椎间隙高度,改善腰椎功能;与正中入路相比,Wiltse入路MIS-LIF切口更小,能进一步减少术中损伤,增强术后早期疗效,利于患者康复。

Objective To evaluate the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)by two different approaches for the treatment of single-segment degenerative lumbar spondylolisthesis(DLS),and to explore the effects of two surgical procedures on the expressions of serum transforming growth factor(TGF)-β1 and receptor for advanced glycation end product(RAGE).Methods From March 2014 to December 2018,70 patients with single-segment DLS admitted to People's Hospital of Chongqing Bishan District were selected.All patients were treated with MIS-TLIF and were divided into two groups according to the different surgical approaches.Patients in group A and group B received Wiltse approach and median approach respectively,with 35 patients in each group.Results The incision length and hospital stay in group A were shorter than those in group B,estimate intraoperative blood loss volume was less than that in group B,while the operation time of group A were longer than group B.Visual analogue scale(VAS)score and Japanese Orthopaedic Association(JOA)score in group A were better than those of group B at 1 month after surgery.The differences between the two groups of the above indicators were statistically significant(P<0.05).The expression of serum TGF-β1 and RAGE at 3 and 7 days after surgery,as well as VAS score,JOA score,lumbar lordosis angle,intervertebral lordosis angle,and intervertebral space height at 1 and 3 months after surgery were improved when compared with preoperative ones(P<0.05).There were no statistical differences between group A and group B in the incidence of complications(9%vs 11%)and the rate of intervertebral fusion[(92.5±3.8)%vs(90.9±4.0)%]at the last follow-up(P>0.05).Conclusions Treatment of MIS-TLIF for single-segment DLS can improve the postoperative serum TGF-β1 and RAGE expressions,relieve the pain symptoms,restore normal physiological curvature and intervertebral space,and enhance the lumbar functions.Compared with the median approach,MIS-TLIF by the Wiltse approach can further reduce intraoperative injuries and improve early postoperative effects,which is conducive to the recovery of patients.