经椎间孔入路腰椎椎间融合术治疗连续双节段腰椎滑脱

Transforaminal lumbar interbody fusion for treatment of continuous double-level lumbar spondylolisthesis

目的分析经椎间孔入路腰椎椎间融合术(TLIF)治疗连续双节段腰椎滑脱(LS)的临床疗效。方法2015年1月—2021年5月,采用TILF治疗连续双节段腰椎前滑脱患者36例,记录所有患者手术时间、术中出血量及并发症发生情况。术前、术后48 h及末次随访时采用腰腿痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)评估腰椎功能情况。测量并比较术前、术后及末次随访时标准站立位全脊柱正侧位X线片上滑脱距离(SD)、滑脱角度(SA)、胸椎后凸角(TK)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、矢状位垂直轴(SVA)、T1骨盆角(TPA)、T1倾斜角(T1S)、胸腰和谐角(TLA)、PI与LL差值(PI-LL)等影像学参数。结果所有手术顺利完成,手术时间为120~275(190.28±6.12)min,术中出血量为210~550(345±11)mL。所有患者术后和末次随访SD、SA较术前明显改善,差异均有统计学意义(P<0.05)。所有患者术后48 h及末次随访时LL、PT、SS、SVA、TPA、T1S、PI-LL较术前显著改善,差异均有统计学意义(P<0.05),且术后48 h与末次随访差异无统计学意义(P>0.05)。术后48 h及末次随访TK、PI、TLA与术前相比,差异无统计学意义(P>0.05)。所有患者术后48 h及末次随访腰腿痛VAS评分、JOA评分、ODI较术前显著改善,差异均有统计学意义(P<0.05),且末次随访时与术后48 h相比进一步改善,差异有统计学意义(P<0.05)。其中2例患者术后当天出现下肢麻木症状,给予营养神经药物后症状均于7 d后明显缓解。结论TLIF可有效缓解连续双节段LS患者症状,改善腰椎功能,同时在恢复椎体滑移的基础上进一步改善脊柱矢状位形态,提高患者生活质量。

Objective To analyze the clinical effect of transforaminal lumbar interbody fusion(TLIF)in the treatment of continuous double-level lumbar spondylolisthesis(LS).Methods From January 2015 to May 2021,36 patients with continuous double-level lumbar anterior spondylolisthesis were treated with TILF in our hospital.Operation time,intraoperative blood loss and complications were recorded.Visual analog scale(VAS)score,Japanese Orthopaedic Association(JOA)score,and Oswestry disability index(ODI)were used to evaluate the lumbar function at pre-operation,postoperative 48h and final follow-up.The sagittal parameters were measured and compared on standard standing full spine roentgenograph,including spondylolisthesis distance(SD),spondylolisthesis angle(SA),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),sagittal vertical axis(SVA),T1 pelvic angle(TPA),T1 spinopelvic inclination(T1S),thoracic lumbar angle(TLA),PI minus LL(PI-LL)at pre-operation,post-operation and the final follow-up.Results All the operations were successfully completed.The operation time was 120-275(190.28±6.12)min,and intraoperative blood loss was 210-550(345±11)mL.SD and SA were significantly improved in all the patients at postoperative 48h and the final follow-up compared with those at pre-operation,all with a statistical significance(P<0.05).LL,PT,SS,SVA,TPA,T1S and PI-LL were significantly improved in all the patients at postoperative 48h and the final follow-up compared with those at pre-operation,all with a statistical significance(P<0.05),and there was no statistically significant difference between the postoperative 48h and the final follow-up(P>0.05).TK,PI and TLA at postoperative 48h and the final follow-up were not significantly improved compared with those before operation(P>0.05).VAS score,JOA score and ODI of all the patients at postoperative 48h and final follow-up were significantly improved compared with those at pre-operation,all with a statistical significance(P<0.05);and were further improved at the final follow-up compared with those at postoperative 48 h,with a statistical significance(P<0.05).Two of the patients had symptoms of lower limb numbness on the day after surgery,which were significantly relieved 7 d later after the administration of neurotrophic drugs.Conclusion TLIF can effectively relieve the symptoms and improve the lumbar function of patients with continuous double-level LS,and further improve the spinal sagittal sequence on the basis of recovering spondylolisthesis,and improve the quality of life of the patients.