TLIF远端凹侧撑开矫正冠状失平衡退行性腰椎畸形

TLIF with distraction on distal concave side for degenerative lumbar scoliosis with coronal imbalance

[目的]探讨经椎间孔椎体融合术(transforaminal lumbar interbody fusion, TLIF)远端凹侧撑开矫正冠状面失平衡退行性腰椎畸形的临床效果。[方法]回顾性分析手术治疗的42例冠状面失平衡退变性腰椎畸形患者的临床资料,其中,B型26例,C型16例,均采用TLIF联合远端凹侧撑开术矫正,比较两组间围手术期、随访和影像资料。[结果]两组患者均顺利手术,两组间早期并发症的差异无统计学意义(P>0.05)。末次随访时两组间腰痛VAS和ODI评分均显著降低(P<0.05)。末次随访时,两组间VAS和ODI评分的差异均无统计学意义(P>0.05)。影像方面,两组患者的侧凸Cobb角、腰骶部倾斜角、冠状面躯干偏移、骨盆倾斜角、骨盆入射角与腰椎前凸角差值和矢状面平衡均较术前显著降低(P<0.05),相应时间点两组间上述影像参数的差异均无统计学意义(P>0.05)。[结论]采用TLIF联合远端凹侧撑开可有效矫正冠状面失平衡退行性腰椎畸形,恢复脊柱平衡。

[Objective] To explore the clinical outcomes of transforaminal lumbar interbody fusion(TLIF) with distraction on distal compensatory concave side for degenerative lumbar scoliosis with coronal imbalance. [Method] A retrospective study was conducted on 42 patients who underwent surgical correction for degenerative lumbar scoliosis with coronal imbalance. Among them, 26 patients were of Bao Type B and the remaining 16 patients were of type C. All the patients in both groups received TLIF with distraction on distal compensatory concave side. The data regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups were successfully operated, with no significant difference in early complications between the two groups(P>0.05). At the last follow-up the VAS and ODI scores significantly reduced in both groups compared with those before operation(P<0.05);whereas no statistically significant differences in VAS and ODI scores were noted between the two groups at the latest follow up(P>0.05). In terms of imaging, scoliotic Cobb angle, lumbosacral tilt angle, CI, PT, PI-LL and SVA significantly decreased at the latest follow up in both groups in contrast to those before surgery(P<0.05), and no a statistically significant difference in the above-mentioned imaging parameters was proved between the two groups at the corresponding time point(P>0.05). [Conclusion] The TLIF with distraction on distal compensatory concave side does effectively correct degenerative lumbar scoliosis with coronal imbalance, and restore spinal balance.