摘要
目的比较微创经椎间孔腰椎椎体间融合术（MIS-TLIF）Wiltse入路与正中入路治疗单节段退变性腰椎滑脱的疗效。方法单节段退变性腰椎滑脱症患者70例,随机分为Wiltse入路组（n=32）和正中入路组（n=38）。Wiltse入路组随访12~24个月,平均18.6个月;正中入路组随访12~22个月,平均16.1个月。术后3、6、12个月随访,评估JOA腰痛评分、腰痛及下肢痛VAS,行影像学检查评估椎间融合及多裂肌萎缩程度。结果两组性别、年龄、滑脱部位、滑脱程度、JOA腰痛评分、腰痛及下肢痛视觉模拟评分（VAS）差异无统计学意义（P〉0.05）。两组平均手术时间差异无统计学意义（P〉0.05）。与正中入路组相比,Wiltse入路组手术切口长度小、显露时间短、显露出血量及总出血量少,差异有统计学意义（P〈0.05）。术后12个月随访,两组JOA腰痛评分及各项VAS评分均较术前改善,差异有统计学意义（P〈0.05）;两组间JOA腰痛评分、改善率和下肢痛VAS差异无统计学意义（P〉0.05）。术后12个月随访时,Wiltse入路组腰痛VAS低于正中入路组,MRI肌萎缩评分高于正中入路组,差异有统计学意义（P〈0.05）。结论两种入路TLIF治疗单节段退变性腰椎滑脱手术疗效相近,但Wiltse入路对多裂肌的损伤比后正中入路小,术后腰背痛等并发症的发生率低。
Objective To compare the clinical efficacy of mini-invasive transforaminal lumbar inter-body fusion（ MIS-TLIF） through Wiltse approach and traditional approach for the treatment of lumbar spondylolisthesis. Methods A total of 70 patients with lumbar spondylolisthesis were randomly divided group A（ n = 32） receiving MIS-TLIF through Wiltse approach and group B（ n = 38） receiving MIS-TLIF through traditional approach. In group A,the affected level was L4 /5 in 20 cases and L5 / S1 in 12 cases; 9 cases had only lowback pain（ LBP）,while 21 cases had both LBP and leg pain; 17 cases had grade I and 14 cases had grade II spondylolisthesis. In group B,the affected level was L4 /5 in 22 cases and L5 / S1 in 16 cases; 11 cases had only LBP,while 27 cases had both LBP and leg pain; 21 cases had grade I and 17 cases had grade II spondylolisthesis. The JOA score,VAS of LBP and leg pain were evaluated3 months,6 months and 1 year after surgery. The post-operative dynamic X-rays,CT and / or MR were used for imaging evaluation. Results There was no difference in gender,age,affected levels,degree of spondylolisthesis,preoperative JOA score,VAS of LBP,and VAS of leg pain between groups A and B（ P〈0. 05）. The incision length,blood loss and exposure time of group A were better than those of group B（ P〈0. 05）. The post-operative JOA scoresand VAS of LBP and leg pain were significantly improved after surgery in both groups A and B. The VAS of LBP in group A was lower than that of group B on day 1,day 14,and 1 year after surgery（ P〉0. 05）. The interbody fusion rate was not significantly different between groups A and B（ P〉0. 05）. There were no complications of internal fixation in both groups. Conclusion MIS-TLIF through both Wiltse and traditional approaches can acquire satisfactory clinical efficacy. Mini-invasive TLIF through Wiltse approach can significantly reduce the damage of multifidus and postoperative incidence of chronic LBP.
出处
《山东大学学报（医学版）》
CAS
北大核心
2015年第12期71-75,共5页
Journal of Shandong University:Health Sciences
