不同入路TLIF对峡部裂型腰椎滑脱症疗效及矢状位影像学参数的影响

Effects of Different Approaches of Transforaminal Lumbar Interbody Fusion on Curative Effect and Sagittal Imaging Parameters of Isthmic Lumbar Spondylolisthesis

探讨不同入路的经椎间孔椎间融合术(TLIF)对峡部裂型腰椎滑脱症患者的疗效及矢状位影像学参数影响差异。选取102例峡部裂型腰椎滑脱症患者,采用随机数字表法分为微创组和开放组,各51例。微创组行Wiltse入路和MAST Quadrant管道下微创TLIF,开放组行传统入路TLIF。统计两组手术情况、治疗优良率。采用X线测定患者手术前后的腰椎-骨盆矢状位影像学参数:腰椎前凸角(LL)、腰骶角(LSA)、L1铅垂线与S1距离(LASD)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、骨盆入射角(PI)、滑脱角(SA)。微创组手术时间、住院时间、术后卧床时间短于开放组,切口长度、术中失血量、术后引流量低于开放组(P<0.05);两组治疗优良率差异无统计学意义(P>0.05);术后6个月两组LL较术前增大,SA较术前减小(P<0.05),但组间差异无统计学意义(P>0.05)。两种入路TLIF均可改善腰椎-骨盆矢状位影像学参数,疗效相当,但Wiltse入路和MAST Quadrant管道下手术更具微创性。

This study investigated the efficacy of transforaminal lumbar interbody fusion(TLIF)with different approaches in patients with isthmic lumbar spondylolisthesis and the differences in the effects of sagittal imaging parameters.A total of 102 patients with isthmic spondylolisthesis were selected and randomly divided into a minimally invasive group and an open group,with 51 cases in each group.The minimally invasive group underwent Wiltse approach and minimally invasive TLIF under the MAST Quadrant channel,and the open group underwent traditional TLIF.The surgical conditions and excellent and good rates of treatment in the two groups were calculated.X-ray was used to determine the lumbar lordosis angle(LL),lumbosacral angle(LSA),distance between L1 plumb line and S1(LASD),pelvic tilt angle(PT),sacral tilt angle(SS),pelvic incidence angle(PI),slip angle(SA)before and after surgery.The operation time,hospital stay,and postoperative bed rest time in the minimally invasive group were shorter than those in the open group,and the incision length,intraoperative blood loss,and postoperative drainage volume were lower than those in the open group(P<0.05).There was no significant difference in the excellent and good rates between the two groups(P>0.05).6 months after operation,LL increased and SA decreased in both groups compared with preoperative(P<0.05),but there was no significant difference between the two groups(P>0.05).Both TLIF approaches can improve lumbar-pelvic sagittal imaging parameters with comparable efficacy,but the Wiltse approach and MAST Quadrant canal are more minimally invasive.