| 术前体位复位联合术中提拉复位辅助 Mis-TLIF技术治疗峡部裂型腰椎滑脱 |
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Received:May 13, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陆联松 |
LU Lian-song |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No. 6 Hospital. Ningbo 315040, Zhejiang, China |
liansongsd@163.com |
| 孙韶华 |
SUN Shao-hua |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No. 6 Hospital. Ningbo 315040, Zhejiang, China |
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| 李豪杰 |
LI Hao-jie |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No. 6 Hospital. Ningbo 315040, Zhejiang, China |
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| 胡勇 |
HU Yong |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No. 6 Hospital. Ningbo 315040, Zhejiang, China |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No. 6 Hospital. Ningbo 315040, Zhejiang, China |
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| 期刊信息：《中国骨伤》2024年37卷，第10期，第965-971页 |
| DOI：10.12200/j.issn.1003-0034.20231196 |
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目的: 探讨应用微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,Mis-TLIF)结合术前体位复位治疗峡部裂型腰椎滑脱的临床效果并总结其优点。
方法: 回顾性分析2016年7月至2022年7月收治的60例腰椎峡部裂型滑脱患者,其中男26例,女34例;年龄35~72(51.32±4.24)岁。依据手术方式分为观察组和对照组。观察组30例,男12例,女18例;年龄 35~71(51.80±6.38)岁;病程12~60(24.17±1.98)个月;L4滑脱 18例,L5滑脱 12 例;Meyerding分级Ⅰ度滑脱20例,Ⅱ度滑脱10例;采用术前体位复位联合术中撑开复位后经Quadrant通道Mis-TLIF。对照组30例,男 14 例,女 16 例;年龄 36~72(50.00 ±4.24)岁;病程 12~60(23.70±1.53)个月;L4 滑脱16例,L5 滑脱14例;Meyerding分级Ⅰ度滑脱19例,Ⅱ度滑脱11例;采用传统后路开放椎体融合术治疗。分析两组的手术时间、术中及术后出血量、术后住院时间、放射线暴露时间和并发症等方面的差异。采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分(腰椎评分标准)评估临床效果,随访复查X线及CT评估椎间融合情况。
结果: 所有患者获得12个月的随访。两组在手术时间、腰痛VAS、滑脱角、滑脱率等方面差异无统计学意义(P＞0.05)。观察组术中术后出血量(165.50±15.56)、(59.17±10.59) ml,均少于对照组(259.33±35.32)、(165.33±29.56) ml(P＜0.05);观察组住院时间(3.53±0.68) d,少于对照组(5.20±0.41) d(P＜0.05);末次随访时两组椎间隙高度、滑脱角、滑脱率、ODI、VAS、JOA 评分均较术前明显改善(P＜0.05)。末次随访观察组与对照组ODI[(9.93±1.11)% vs (10.93±1.11)%]和JOA[(26.07±1.01)分 vs (25.43±1.25)分]比较,差异有统计学意义(P＜0.05)。
结论: 在峡部裂型腰椎滑脱的治疗中,术前体位复位联合术中提拉复位辅助 Mis-Tlif技术相比传统开放性手术具有创伤小、出血少、住院周期短等优点,是一种安全有效的技术。 |
| [关键词]:峡部裂型腰椎滑脱 Mis-TLIF Quadrant通道 经椎间孔椎体融合术 体位复位 |
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| Clinical study of isthmic spondylolisthesis treated with Mis-TLIF assisted by preoperative posture reduction and intraoperative lifting reduction |
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Abstract:
Objective To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion(Mis-TLIF) technique combined with preoperative position reduction in the treatment of spondylolisthesis and summarize its advantages.
Methods Between July 2016 and July 2022,60 patients with lumbar isthmic spondylolisthesis were retrospectively analyzed,including 26 males and 34 females,with an average age of (51.32±4.24) years old ranging from 35 to 72 years old. They were divided into observation group and control group according to the operation methods. There were 30 patients in the observation group,including 12 males and 18 females;the age ranged from 35 to 71 years old with an average of(51.80±6.38) years old,the course of disease ranged from 12 to 60 months with an average of (24.17±1.98) months;there were 18 cases of L4 spondylolisthesis and 12 cases of L5 spondylolisthesis;according to Meyerding classification,there were 20 cases of grade Ⅰ spondylolisthesis and 10 cases of gradeⅡ. The observation group was treated with preoperative postural reduction combined with intraoperative reduction assisted minimally invasive transforaminal lumbar fusion via Quadrant channel(Mis-TLIF). There were 30 patients in the control group,including 14 males and 16 females,with an average of (50.00±4.24) years old ranging from 36 to 72 years old;the course of disease ranged from 12 to 60 months with an average of (23.70±1.53) months;there were 16 cases of L4 spondylolisthesis and 14 cases of L5 spondylolisthesis;according to Meyerding classification,there were 19 cases of grade Ⅰ spondylolisthesis and 11 cases of grade Ⅱ. The control group was treated with open transforaminal lumbar interbody fusion(Open-TLIF). The differences of operation time,intraoperative and postoperative blood loss,hospital stay,radiation exposure time and complications between the two groups were analyzed. Visual analogue scale (VAS),Oswestry disability index (ODI) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical effect. X-ray and CT were followed up to evaluate the interbody fusion..
Results All patients were followed up for 12 months. There was no significant difference in operation time,VAS of low back pain,slip angle and slip rate between two groups (P＞0.05). The intraoperative and postoperative blood loss in the observation group (165.50±15.56) ml and (59.17±10.59) ml were less than those in the control group (259.33±35.32) ml and (165.33 ±29.56) ml (P＜0.05). The length of hospital stay in the observation group (3.53±0.68) days was less than that in the control group (5.20±0.41) days (P＜0.05).The intervertebral space height,slip angle,slip rate,ODI,VAS and JOA scores were significantly improved in the two groups at the final follow-up (P＜0.05). There were significant differences in ODI[(9.93±1.11)% vs (10.93±1.11)%] and JOA[(26.07±1.01) points vs (25.43±1.25) points] between the observation group and the control group at the final follow-up (P＜0.05).
Conclusion In the treatment of spondylolisthesis,preoperative position reduction combined with intraoperative reduction assisted Mis-Tlif technique has advantages of less trauma,less bleeding and shorter hospitalization period than traditional open surgery. It is a safe and effective technique. |
| KEYWORDS:Isthmic lumbar spondylolisthesis Mis-TLIF Quadrant channel Transforaminal vertebral body fusion Postural reduction |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陆联松,孙韶华,李豪杰,胡勇,马维虎.术前体位复位联合术中提拉复位辅助 Mis-TLIF技术治疗峡部裂型腰椎滑脱[J].中国骨伤,2024,37(10):965~971 |
| 英文格式: | LU Lian-song,SUN Shao-hua,LI Hao-jie,HU Yong,MA Wei-hu.Clinical study of isthmic spondylolisthesis treated with Mis-TLIF assisted by preoperative posture reduction and intraoperative lifting reduction[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(10):965~971 |
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