Wiltse入路联合TLIF治疗腰椎滑脱症的中远期疗效

Medium and long-term efficacy of Wiltse approach combined with TLIF in the treatment of lumbar spondylolisthesis

目的探讨Wiltse入路联合经椎间孔椎体间融合术(TLIF)治疗轻、中度腰椎滑脱症的中远期临床效果。方法回顾性分析我院经不同入路联合TLIF治疗的轻、中度腰椎滑脱症患者的临床资料,其中微创组(35例)采用经Wiltse入路,后正中组(46例)采用传统后正中入路,所有患者均随访8年以上。比较患者术前、术后不同时间点疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)以评定临床疗效;测量多裂肌面积以评价多裂肌萎缩情况;比较2组椎间融合、邻椎病、内固定失效等情况以评价中远期疗效。结果微创组和后正中组的随访时间分别为(112.5±8.4)个月、(137.1±5.8)个月。术后1年、末次随访时微创组腰痛VAS评分低于后正中组,差异有统计学意义(P<0.05);2组不同时间点下肢痛VAS评分差异无统计学意义(P>0.05)。末次随访时微创组ODI低于后正中组,差异有统计学意义(P<0.05)。2组患者术后1年及末次随访时多裂肌净横截面积均小于术前,差异有统计学意义(P<0.05);微创组术后1年及末次随访时多裂肌净横截面积均明显大于后正中组,差异有统计学意义(P<0.05)。末次随访时,2组患者均未发现内固定松动、断裂、椎间融合器移位等内固定失效现象,2组患者椎间融合率及邻椎病发生率比较,差异无统计学意义(P>0.05)。结论Wiltse入路联合TILF治疗轻、中度腰椎滑脱症疗效确切,与后正中入路相比,Wiltse入路能更有效地缓解患者远期下腰痛症状。

Objective To investigate the medium and long-term clinical effects of Wiltse approach combined with transforaminal lumbar interbody fusion(TLIF)in the treatment of mild to moderate lumbar spondylolisthesis.Methods The clinical data of patients with mild to moderate lumbar spondylolisthesis treated by different approaches combined with TLIF in our hospital were retrospectively analyzed.Among them,the minimally invasive group(35 cases)adopted Wiltse approach,and the posterior midline group(46 cases)adopted traditional posterior midline approach.All these patients were followed up for more than 8 years.The visual analogue scale(VAS)score and Oswestry disability index(ODI)at different time points before and after surgery were compared to evaluate the clinical efficacy.Multifidus muscle area was measured to evaluate the multifidus atrophy.Interbody fusion,adjacent vertebra disease and internal fixation failure were compared between the two groups to evaluate the medium and long-term efficacy.Results The follow-up time of the minimally invasive group and the posterior midline group were(112.5±8.4)months and(137.1±5.8)months,respectively.The VAS score of low back pain in the minimally invasive group was lower than that in the posterior midline group at 1 year after surgery and the last follow-up(P<0.05).There was no statistically significant difference in VAS score of lower limb pain at different time points between the two groups(P>0.05).At the last follow-up,ODI in the minimally invasive group was lower than that in the posterior midline group,with statistically significant difference(P<0.05).The net cross-sectional areas of multifidus muscle in both groups at 1 year after surgery and the last follow-up were smaller than that before surgery,with statistically significant differences(P<0.05).The net cross-sectional area of multifidus muscle in the minimally invasive group was significantly larger than that in the posterior midline group at 1 year after surgery and the last follow-up,with statistically significant difference(P<0.05).At the last follow-up,no internal fixation failures such as internal fixation loosening,fracture or interbody fusion device displacement occurred in the two groups,and there was no statistically significant difference in the rate of interbody fusion and incidence of adjacent vertebral diseases between the two groups(P>0.05).Conclusion Wiltse approach combined with TILF is effective in the treatment of mild to moderate lumbar spondylolisthesis.Compared with the posterior midline approach,Wiltse approach can more effectively alleviate the symptoms of long-term low back pain.