| Quadrant通道下的MIS-TLIF治疗Ⅰ度、Ⅱ度退行性腰椎滑脱的疗效研究 |
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投稿时间：2018-06-21 修订日期：2019-03-02
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| 期刊信息：《中国骨伤》年，第卷，第期，第-页 |
| DOI： |
| 基金项目:甘肃省人民医院院内科研【17GSSY3-3】 |
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| 中文摘要:【摘要】目的：探讨Quadrant通道系统下的微创TLIF（Mis-TLIF）术在治疗Ⅰ度、Ⅱ度退变性腰椎滑脱症中的优势。方法：对2014年3月至2017年3月期间手术治疗的100例Ⅰ度、Ⅱ度退变性腰椎滑脱症患者的临床资料回顾性分析，其中采用Mis-TLIF手术（观察组）治疗50例患者，男性19例，女性31例；年龄44-73岁，平均(49 . 83 ±1 5 . 46)岁；病程6个月~7年，平均（22.18±4.74）月；L4滑脱30例、L5滑脱20例，滑脱椎体椎弓根均完整；按照Meyerding分级:Ⅰ度滑脱29例，Ⅱ度滑脱21例。采用开放性经椎间孔腰椎椎体间融术（Open-TLIF）手术（对照组）治疗50例患者，男性23例，女性27例；年龄40-77岁，平均(50 . 67 ±1 4 . 36)岁；病程6个月~10年，平均（20.56±5.37）月；L4滑脱33例、L5滑脱17例，滑脱椎体椎弓根均完整；按照Meyerding分级:Ⅰ度滑脱34例，Ⅱ度滑脱16例。观察两组患者的手术时间、手术切口长度、术中出血量、术后引流量、术前及术后第1天血清肌酸激酶（CK-MM）水平；比较两组术前及术后的VAS评分（视觉模拟评分法）、JOA评分（腰椎评分标准）、ODI评分（Oswestry功能障碍指数）；根据影像学资料比较两组术前及术后第12个月（末次随访）的滑脱率、椎间隙高度及滑脱角；根据术后第6、12个月随访时的腰椎X线片和CT评价椎间融合情况；根据术后第12个月腰椎功能MacNab标准评定优良率。结果：所有患者获得随访，时间为12个月。观察组手术时间（118.48±21.97）min，手术切口长度（3.74±0.74）cm，术中出血量（148.78±32.32）ml，术后引流量（84.85±16.37）ml，CK-MM水平术前（72.31±9.79）u/L、术后第1天（415.12±25.89）u/L；对照组手术时间（115.40±11.94）min，手术切口长度（8.46±0.69）cm，术中出血量（219.27±48.33）ml，术后引流量（157.69±31.61）ml， CK-MM水平术前（75.48±10.73）u/L、术后第1天（506.69±37.86）u/L；观察组术中出血量、术后引流量、手术切口长度、术后第1天CK-MM水平均小于对照组（P<0.05)，但手术时间及术前CK-MM水平两组对比差异无统计学意义(P>0.05)。术前ODI、VAS、JOA评分两组相比无明显差异(P>0.05)，术后两组ODI、VAS、JOA评分均较术前明显改善（P<0.05)，并且术后观察组均优于对照组(P<0.05)；末次随访时同一组内滑脱率、滑脱角、椎间隙高度均较术前明显改善(P<0.05)，但两组间比较差异无统计学意义(P>0.05)；术后第6、12个月椎间融合情况两组相比差异无统计学意义(P>0.05)；根据腰椎功能MacNab评定标准，观察组优40例、良7例、可3例，优良率为94.00% ；对照组优35例、良10例、可5例，优良率为90.00%。观察组50例患者中1例发生切口渗出、延迟愈合；对照组50例患者中1例出现腰5椎体右侧局部肌肉坏死、渗出，不同时间的3次分泌物细菌培养均提示阴性，再次手术彻底清创后取出右侧内固定装置，最后获得延迟愈。结论：Quadrant通道下的Mis-TLIF在手术治疗Ⅰ度、Ⅱ度退变性腰椎滑脱症中创伤小、出血少、功能恢复快和效果好。 |
| 【关键词】Quadrant通道 微创 经椎间孔腰椎椎体间融合 退行性腰椎滑脱 |
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| Efficacy of transforaminal lumbar interbody fusion under Quadrant channels for degenerative lumbar spondylolisthesis of grade I and II |
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| ABSTRACT ABSTRACT Objective: To investigate the advantages of minimally invasive TLIF (Mis-TLIF) in the treatment of grade I and II degree degenerative lumbar spondylolisthesis.Methods: The clinical data of 100 patients with grade I and II degree degenerative lumbar spondylolisthesis treated from March 2014 to March 2017 were retrospectively analyzed，50 patients were treated with Mis-TLIF surgery (observation group),19 males and 31 females；aged 44-73 years, mean (49.83 ± 15.56) years；course of disease 6 months to 7 years, mean (22.18±4.74) months； L4 slippage 30 cases, L5 slippage 20 cases, the vertebral pedicles were completely intact；according to Meyerding classification: 29 cases of I degree slip and 21 cases of II degree slip. 50 patients were treated with open transforaminal lumbar interbody fusion (Open-TLIF) surgery (control group), 23 males and 27 females；aged 40-77 years, mean (50. 67 ± 1 4 36) years old；course of disease from 6 months to 10 years, mean (20.56±5.37) months；L4 slippage in 33 cases, L5 slippage in 17 cases, slippage vertebral pedicles were complete；according to Meyerding classification: 34 cases of I degree slip and 16 cases of II degree slip. The operation time, length of surgical incision, intraoperative blood loss, postoperative drainage, and serum creatine kinase (CK-MM) levels before and 1 day after surgery were observed. The VAS scores (visual analogue scale), JOA score (lumbar spine score), and ODI score (Oswestry dysfunction index) were compared between the two groups before and after surgery. According to the imaging data, the slip rate, intervertebral space height and slip angle of the two groups before and 12 months (last follow-up) were compared. Intervertebral fusion was evaluated according to lumbar X-ray and CT at follow-up at 6 and 12 months postoperatively. The excellent rate was evaluated according to the MacNab criteria for lumbar function in the 12th month after surgery. Results: All patients were followed up for 12 months. Observation group: operation time (118.48±21.97) min, length of surgical incision (3.74±0.74) cm, intraoperative blood loss (148.78±32.32) ml, postoperative drainage (84.85±16.37) ml, CK-MM level before surgery (72.31±9.79) u/L and the first day after surgery (415.12±25.89) u/L. Control group: operation time (115.40±11.94) min, length of surgical incision (8.46±0.69) cm, intraoperative blood loss (219.27±48.33) ml, postoperative drainage (157.69±31.61) ml, CK-MM level before surgery (75.48±10.73) u/L and the first day after surgery (506.69±37.86) u/L. The intraoperative blood loss, postoperative drainage volume, length of surgical incision, and CK-MM level on the first postoperative day were lower in the observation group than in the control group (P<0.05), but the operation time and preoperative CK-MM levels in the two groups were compared, the difference was not statistically significant (P>0.05). There were no significant differences in ODI, VAS, and JOA scores before surgery (P>0.05). The scores of ODI, VAS, and JOA were significantly improved after surgery (P<0.05), and the scores of the observation group were better than those of the control group (P<0.05). At the last follow-up, the slip rate, slip angle and intervertebral space height were significantly improved in the same group (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in intervertebral fusion between the two groups at 6 and 12 months after operation (P>0.05). According to the MacNab standard, the excellent and good rate of the observation group was 94%, while that of the control group was 90%. In the observation group, 1 patients had delayed healing of incisional exudation. In the control group, 1 patients had local muscle necrosis on the right side of the lumbar 5 vertebrae, and the bacterial culture of the secretions at three times was negative, and the right internal fixation device was taken out after the second operation completely debridement, and the delayed healing was finally obtained. Conclusion: The Mis-TLIF under the Quadrant channel has less trauma, less bleeding, faster function recovery and better effect in surgical treatment of grade I and II degree degenerative lumbar spondylolisthesis. |
| KEY WORDS Quadrant channel, minimally invasive, transforaminal lumbar interbody fusion,degenerative lumbar spondylolisthesis. |
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