双侧可扩张通道下MIS-TLIF治疗单节段峡部裂性腰椎滑脱症
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中国人民解放军总医院第一医学中心

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国家自然科学基金项目(面上项目,重点项目,重大项目)


Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion for single-level lumbar isthmic spondylolisthesis
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The First Medical Center of PLA General Hospital

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    摘要:

    [目的] 探讨双侧可扩张通道下经椎间孔椎间融合术(MIS-TLIF)治疗单节段峡部裂性腰椎滑脱症的可行性及临床疗效。[方法] 2015年9月至2017年8月,采用双侧可扩张通道辅助下MIS-TLIF治疗的单节段峡部裂性腰椎滑脱症患者21例,男9例,女12例,其中Meyerding II度滑脱16例,III度滑脱5例。记录手术时间、术中出血量、术后住院时间、并发生发生情况,对比术前、术后、术后随访期间腰部及腿部视觉模拟评分(Visual analogue scores,VAS)、Oswestry 障碍指数(Oswestry disability index,ODI)、滑脱率、局部矢状位Cobb角变化,并观察椎间融合情况。 [结果] 21例患者手术顺利,平均手术时间(202.4±28.3)min,术中出血量(242.9±89.8)ml,2例术中硬膜撕裂,均予一期硬脊膜缝合,未出现脑脊液漏及切口不愈合,未出现置钉相关神经损伤,两组均未出现感染及术后非症状侧根性症状加重,术后住院时间(4.5±1.9)天。术前腰痛VAS (6.7±1.31)分,末次随访(2.1±1.0)分,术前腿痛(6.8±1.8)分,末次随访(0.7±0.7)分,ODI 术前52.2%±13.1%,末次随访14.7%±6.2% ,局部Cobb角从10.4°±9.3°到末次随访19.0°±3.7°,滑脱率从39.9%±13.1%到末次随访6.6%±4.2%,末次随访时,Bridwell I级14例、II级7例,未出现椎弓根螺钉断裂。 [结论] 采用双侧可扩张通道辅助下经椎间孔椎体间融合术治疗单节段峡部裂性腰椎滑脱症,创伤小,且安全,有效。

    Abstract:

    [Objective] To investigate the practicability and clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar isthmic spondylolisthesis with bilateral expandable tubular channels. [Methods] From September 2015 to August 2017, 21 patients with single-level lumbar isthmic spondylolisthesis were treated with MIS-TLIF assisted by bilateral expandable channels,There were 9 males and 12 females, including 16 cases of slippage degree II and 5 cases of degree III. The operation time, intraoperative blood loss, hospitalization time after surgery, complication rate and incidence of asymptomatic lateral root symptoms were recorded. Visual analogue scores (VAS), Oswestry disability index (ODI) , Slippage rate and local Cobb angle were recorded before operation, and follow-up. Lumbar spine X-ray and CT were taken 12 months after operation to judge the intervertebral bony fusion. [Results] The average operation time was (202.4 +28.3) min and blood loss was (242.9 +89.8) ml. During the operation, 2 cases had dural tear, which were sutured immediately without cerebrospinal fluid leakage and incision nonunion, no nail-related nerve injury, infection and asymptomatic lateral root symptoms aggravated occurred after operation, postoperative hospital stay was (4.5 +1.9) days. Preoperative low back pain VAS score, leg pain VAS score, ODI, local Cobb angle and Slippage rate were 6.7±1.31, 6.8±1.8, 52.2%±13.1%, 10.4°±9.3°, 39.9%±13.1% while at final follow-up were 2.1±1.0, 0.7±0.7, 14.7%±6.2% ,19.0°±3.7°, 6.6%±4.2%. 14 cases of Bridwell I and 7 cases of Bridwell II intervertebral fusion at final follow-up and no pedicle screw crack. [Conclusion] MIS-TLIF with bilateral expandable tubular channels is safe and effective approach for single-level lumbar isthmic spondylolisthesis.

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  • 收稿日期:2019-05-02
  • 最后修改日期:2019-05-06
  • 录用日期:2019-07-15
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