腰后路双侧微创Wiltse入路万向椎弓根钉置入术治疗腰椎滑脱症患者的效果

Effects of polyaxial pedicle screw placement through posterior lumbar bilateral minimally invasive Wiltse approach in treatment of patients with lumbar spondylolisthesis

目的:观察腰后路双侧微创Wiltse入路万向椎弓根螺钉(PS)置入术治疗腰椎滑脱症(LS)患者的效果。方法:选取2019年1月至2021年3月该院收治的108例LS患者进行前瞻性研究,按照随机数字表法分为对照组和研究组各54例。对照组实施后正中入路经椎间孔腰椎椎间体融合(TLIF)术治疗,研究组实施腰后路双侧微创Wiltse入路万向PS置入术治疗,比较两组手术相关指标水平,术前及术后1、3个月腰椎功能[Oswestry功能障碍指数问卷表(ODI)]评分,术前及术后3、7 d的疼痛[视觉模拟评分法(VAS)]评分,术前、术后6 h血清学指标[促肾上腺皮质激素(ACTH)、皮质醇(Cor)]水平,以及并发症发生率。结果:研究组手术时间短于对照组,术中出血量和术后引流量均少于对照组,差异有统计学意义(P<0.05);术后1、3个月,研究组ODI评分均低于对照组,差异有统计学意义(P<0.05);术后3、7 d,研究组VAS评分均低于对照组,差异有统计学意义(P<0.05);术后6 h,研究组血清Cor、ACTH水平均低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:腰后路双侧微创Wiltse入路万向PS置入术治疗LS患者,可改善手术相关指标水平,提高腰椎功能,减轻应激反应和术后疼痛,其效果优于TLIF术治疗。

Objective:To observe effects of polyaxial pedicle screw(PS)placement through posterior lumbar bilateral minimally invasive Wiltse approach in treatment of patients with lumbar spondylolisthesis(LS).Methods:The clinical data of 108 patients with LS admitted to the hospital from January 2019 to March 2021 were retrospectively studied.They were divided into control group and study group according to the random number table method,54 cases in each.The control group was treated with posterior midline transforaminal lumbar interbody fusion(TLIF),while the study group was treated with PS placement through the posterior lumbar bilateral minimally invasive Wiltse approach.The levels of operation-related indicators,the lumbar function[Oswestry disability index(ODI)]scores before and 1 and 3 months after the surgery,the pain[visual analogue scale(VAS)]scores before and 3 and 7 days after the surgery,the serological indicator levels[adrenocorticotropic hormone(ACTH),cortisol(Cor)]before and 6 hours after the surgery,and the incidence of complications were compared between the two groups.Results:The operation time of the study group was shorter than that of the control group,the intraoperative blood loss and the postoperative drainage volume were less than those of the control group,and the differences were statistically significant(P<0.05).1 and 3 months after the surgery,the ODI scores of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).3 and 7 days after the surgery,the VAS scores of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).6 h after the surgery,the levels of serum Cor and ACTH in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:The PS placement through the posterior lumbar bilateral minimally invasive Wiltse approach in the treatment of the LS patients can improve the levels of operation-related indicators,improve the lumbar function,and reduce the stress response and the postoperative pain.Moreover,it is superior to TLIF.