摘要
目的探讨Wiltse入路经椎间孔外侧腰椎椎体间融合术(extraforaminal lumbar interbody fusion,ELIF)在治疗单节段Ⅰ、Ⅱ度退变性腰椎滑脱症(degenerative lumbar spondylolisthesis,DLS)的临床疗效分析。方法回顾性分析2018年10月至2022年7月武汉中西医结合骨科医院收治且获得随访的78例单节段MeyerdingⅠ、Ⅱ度DLS患者的临床资料。其中,35例在Wiltse入路下采用ELIF技术治疗(ELIF组),男21例,女14例,年龄40~70(53.66±9.42)岁。43例采用后正中入路经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗(TLIF组),男23例,女20例,年龄40~69(53.09±8.73)岁。同时记录两组患者的手术时间、术中出血量、术后引流量和卧床时间。采用视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)对两组患者进行评定。结果78例患者手术顺利完成,未见明显并发症。所有患者均完成术后随访,随访12~19个月,平均(12.77±1.75)个月。手术时间上,ELIF组与TLIF组比较差异无统计学意义(P>0.05)。ELIF组的术中出血量及术后引流量均低于TLIF组,且患者的卧床时间较TLIF组缩短(P<0.05)。术后3 d、1个月、3个月及6个月ELIF组VAS评分优于TLIF组;而术后12个月时,两组比较差异无统计学意义(P>0.05)。术后1、3个月两组ODI评分比较,差异无统计学意义(P>0.05),而术后6、12个月ELIF组明显优于TLIF组(P<0.05)。随访中,同一治疗组每个时间点ODI较前均有改善。术后ELIF组椎间植骨融合优良率为91.43%;TLIF组的优良率为97.67%,两组比较差异无统计学意义(P>0.05)。结论Wiltse入路辅助下ELIF治疗单节段Ⅰ、Ⅱ度DLS具有创伤小、出血少、术后恢复快等优势,是一种微创、安全、有效的手术方式。
Objective To investigate the clinical efficacy of extraforaminal lumbar interbody fusion(ELIF)through Wiltse approach in the treatment of single-segment MeyerdingⅠandⅡdegree degenerative lumbar spondylolisthesis.Methods Clinical data of 78 patients with single-segment MeyerdingⅠandⅡdegree degenerative lumbar spondylolisthesis admitted to Wuhan Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine from October 2018 to July 2022 were retrospectively analyzed.Thirty-five patients were treated with ELIF technique through Wiltse approach(ELIF group),including 21 males and 14 females,aged(53.66±9.42)years old;43 patients were treated with transforaminal lumbar interbody fusion(TLIF)using posterior median approach(TLIF group),including 23 males and 20 females,aged(53.09±8.73)years old.The operation time,intraoperative bleeding,postoperative drainage,bed rest time and complications were recorded.Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were used to evaluate patients of the two group.Results Seventy-eight patients were successfully completed surgery,without any complications.All patients were followed up for 12-19 months,with a mean of(12.77±1.75)months.There was no significant difference in operation time between the two groups(P>0.05).Intraoperative bleeding was significantly lower in the ELIF group than that in the TLIF group(P<0.05).And after 48 h of drain placement,postoperative drainage was significantly less in the ELIF group than that in the TLIF group(P<0.05).Mean postoperative bed rest was significantly shorter in the ELIF group than in the TLIF group(P<0.05).VAS scores were higher in the ELIF group than in the TLIF group at 3 d,1 month,3 months and 6 months postoperatively,but there was no statistically significant difference between the two groups at 12 months after surgery(P>0.05).At 1 month,3 months postoperatively,there was no statistically significant difference in ODI between the two groups(P>0.05),while the ELIF group was significantly better than the TLIF group at 6 and 12 months postoperatively(P<0.05).At follow-up,the same treatment group showed improvement in ODI at each time point compared with the previous one.The excellent and good rate of postoperative intervertebral implant fusion in the ELIF group was 91.43%;while it was 97.67%in the TLIF group;the difference was not statistically significant between the two groups(P>0.05).Conclusion ELIF through the Wiltse approach for the treatment of single-segment MeyerdingⅠandⅡdegree degenerative lumbar spondylolisthesis has the advantages of less trauma,less bleeding,faster postoperative recovery,and it is a minimally invasive,safe and effective surgical method.
作者
王小阵
席金涛
陈龙
吕鹏
汪雄伟
薛睿
鲁齐林
朱凌
Wang Xiaozhen;Xi Jintao;Chen Long;Lyu Peng;Wang Xiongwei;Xue Rui;Lu Qilin;Zhu Ling(Department of Spine Surgery,Wuhan Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine(The Affiliated Hospital of Wuhan Sports University),Wuhan Hubei,430079,China;Medical School,University of Rostock,Rostock Mecklenburg-Vorpommern,82475,Germany;Sport Medicine College of Wuhan Sports University,Wuhan Hubei,430079,China)
出处
《生物骨科材料与临床研究》
2025年第3期14-19,共6页
Orthopaedic Biomechanics Materials and Clinical Study
基金
2025年体育创新发展联合基金项目(2025AFD625)
湖北省自然科学基金(2023AFB645)。
关键词
腰椎滑脱症
微创
肌间隙入路
经椎间孔外椎体间融合术
Lumbar spondylolisthesis
Minimally invasive
Wiltse approach
Transforaminal lumbar interbody fusion
