MIS-TLIF手术治疗老年退行性腰椎滑脱症的疗效观察
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摘要
目的比较分析微创经椎间孔椎体间融合术(MIS-TLIF)与后路腰椎椎间融合术(PLIF)治疗老年退行性腰椎滑脱症的疗效。方法回顾性分析自2014-01—2016-12诊治的141例老年退行性腰椎滑脱症,78例行MIS-TLIF手术治疗(MIS-TLIF组),63例行PLIF手术治疗(PLIF组)。比较2组手术时间、术中出血量、术后引流量,术后腰背痛VAS评分、腿痛VAS评分、ODI指数、手术节段矢状面Cobb角、滑脱角、椎体滑移度、椎间隙高度。结果 141例均获得随访,随访时间平均17.4(13～37)个月。MIS-TLIF组手术时间较PLIF组短,术中出血量及术后引流量较PLIF组少,术后1、3个月腰背痛VAS评分、腿痛VAS评分及ODI指数低于PLIF组,差异有统计学意义(P <0.05);但术后6、12个月腰背痛VAS评分、腿痛VAS评分、ODI指数,以及末次随访时手术节段Cobb角、滑脱角、椎体滑移度、椎间隙高度差异无统计学意义(P>0.05)。结论 MIS-TLIF手术治疗老年退行性腰椎滑脱症具有创伤小、术后恢复快、可保留脊柱后方骨性稳定结构等优点,能获得良好的临床疗效。
Objective To compare and analyze the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) and posterior lumbar interbody fusion(PLIF) in the treatment of senile degenerative lumbar spondylolisthesis.Methods A retrospective analysis was performed on 141 cases of degenerative lumbar spondylolisthesis diagnosed and treated from January 2014 to December 2016. Among it, 78 cases were treated with MIS-TLIF(MIS-TLIF group) and 63 cases with PLIF(PLIF group). The operative time, intraoperative blood loss, postoperative drainage volume, postoperative VAS score of lumbago and backache, VAS score of leg pain, ODI, Cobb Angle of sagittal plane, angle of slip, vertebral body slip and vertebral space height were compared between the two groups. Results All 141 patients were followed up for an average of 17.4(13-37) months. The surgery time of MIS-TLIF group was shorter than that of PLIF group, and the intraoperative blood loss and postoperative drainage volume of MIS-TLIF were less than that of PLIF group. The VAS score of low back pain, VAS score of leg pain and ODI in MIS-TLIF group were lower than that in PLIF group at 1 and 3 months after surgery, and the differences were statistically significant(P <0.05). However, VAS score of low back pain, VAS score of leg pain, ODI at 6 and12 months after surgery,and Cobb angle, spondylolisthesis angle, vertebral body slip, and intervertebral space height of the operative segment at the last follow-up showed no significant difference(P >0.05). Conclusion The MIS-TLIF surgery for degenerative lumbar spondylolisthesis in the elderly has the advantages of less trauma, rapid postoperative recovery, and the retention of bone stable structure in the posterior spine.
Objective To compare and analyze the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) and posterior lumbar interbody fusion(PLIF) in the treatment of senile degenerative lumbar spondylolisthesis.Methods A retrospective analysis was performed on 141 cases of degenerative lumbar spondylolisthesis diagnosed and treated from January 2014 to December 2016. Among it, 78 cases were treated with MIS-TLIF(MIS-TLIF group) and 63 cases with PLIF(PLIF group). The operative time, intraoperative blood loss, postoperative drainage volume, postoperative VAS score of lumbago and backache, VAS score of leg pain, ODI, Cobb Angle of sagittal plane, angle of slip, vertebral body slip and vertebral space height were compared between the two groups. Results All 141 patients were followed up for an average of 17.4(13-37) months. The surgery time of MIS-TLIF group was shorter than that of PLIF group, and the intraoperative blood loss and postoperative drainage volume of MIS-TLIF were less than that of PLIF group. The VAS score of low back pain, VAS score of leg pain and ODI in MIS-TLIF group were lower than that in PLIF group at 1 and 3 months after surgery, and the differences were statistically significant(P <0.05). However, VAS score of low back pain, VAS score of leg pain, ODI at 6 and12 months after surgery,and Cobb angle, spondylolisthesis angle, vertebral body slip, and intervertebral space height of the operative segment at the last follow-up showed no significant difference(P >0.05). Conclusion The MIS-TLIF surgery for degenerative lumbar spondylolisthesis in the elderly has the advantages of less trauma, rapid postoperative recovery, and the retention of bone stable structure in the posterior spine.
引文
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[10]Mummaneni PV,Bisson EF,Kerezoudis P,et al.Minimally invasive versus open fusion for GradeⅠdegenerative lumbar spondylolisthesis:analysis of the Quality Outcomes Database[J].Neurosurg Focus,2017,43(2):E11.
[11]Khan NR,Clark AJ,Lee SL,et al.Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion:an updated systematic review and meta-analysis[J].Neurosurgery,2015,77(6):847-874.
[12]Lu VM,Kerezoudis P,Gilder HE,et al.Minimally invasive surgery versus open surgery spinal fusion for spondylolisthesis:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2017,42(3):E177-E185.
[2]Serban D,Calina N,Tender G.Standard versus minimally invasive transforaminal lumbar interbody fusion:a prospective randomized study[J].Biomed Res Int,2017,2017:7236970.
[3]Meyerding HW.Spondylolisthesis;surgical fusion of lumbosacral portion of spinal column and interarticular facets;use of autogenous bone grafts for relief of disabling backache[J].J Int Coll Surg,1956,26(5 part1):566-591.
[4]Mura PP,Costaglioli M,Piredda M,et al.TLIF for symptomatic disc degeneration:a retrospective study of 100 patients[J].Eur Spine J,2011,20 Suppl 1:S57-S60.
[5]Price JP,Dawson JM,Schwender JD,et al.Clinical and radiologic comparison of minimally invasive surgery with traditional open transforaminal lumbar interbody fusion:a review of 452 patients from a single center[J].Clin Spine Surg,2018,31(2):E121-E126.
[6]杨祖清,颉强,李天清,等.Wiltse入路经椎间孔椎体间融合术治疗腰椎滑脱症的疗效观察[J].中国脊柱脊髓杂志,2015,25(6):503-510.
[7]周敏,张群虎,刘欢,等.MISTLIF与Open TLIF治疗单节段腰椎滑脱疾病疗效的Meta分析[J].南京医科大学学报(自然科学版),2015,35(1):131-138.
[8]Massie LW,Zakaria HM,Schultz LR,et al.Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis[J].Neurosurg Focus,2018,44(1):E8.
[9]Wu RH,Fraser JF,Hartl R.Minimal access versus open transforaminal lumbar interbody fusion:meta-analysis of fusion rates[J].Spine(Phila Pa 1976),2010,35(26):2273-2281.
[10]Mummaneni PV,Bisson EF,Kerezoudis P,et al.Minimally invasive versus open fusion for GradeⅠdegenerative lumbar spondylolisthesis:analysis of the Quality Outcomes Database[J].Neurosurg Focus,2017,43(2):E11.
[11]Khan NR,Clark AJ,Lee SL,et al.Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion:an updated systematic review and meta-analysis[J].Neurosurgery,2015,77(6):847-874.
[12]Lu VM,Kerezoudis P,Gilder HE,et al.Minimally invasive surgery versus open surgery spinal fusion for spondylolisthesis:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2017,42(3):E177-E185.