双侧小切口Wiltse入路经椎间孔腰椎椎体间融合术治疗老年腰椎退变性疾病的疗效观察

Efficacy of bilateral mini-open Wiltse approach transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases in the elderly

中文关键词:  腰椎退变性疾病  微创经椎间孔腰椎椎体间融合术  经皮置钉  Wiltse入路

英文关键词:Lumbar degenerative disease  Minimally invasive transforaminal lumbar interbody fusion  Percutaneous pedicle screw placement  Wiltse approach

中文摘要:

  【摘要】目的：探讨双侧小切口Wiltse入路经椎间孔腰椎椎体间融合术（mini-open transforaminal lumbar interbody fusion，MO-TLIF）治疗老年腰椎退变性疾病的临床疗效。方法：回顾性分析2017年9月~2020年8月在海军军医大学第一附属医院行MO-TLIF或微创经椎间孔腰椎椎体间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）治疗的62例老年单节段腰椎退变性疾病患者，男37例，女25例，年龄68.0±5.5岁；其中MO-TLIF组32例，MIS-TLIF组30例。两组患者的性别比、年龄、体重指数（body mass index，BMI）、手术节段、病程、随访时间等均无统计学差异（P>0.05），比较两组手术时间、术中出血量、术中透视次数、术后切口引流量、下地活动时间、住院时间、并发症、植骨融合率等方面的差异；术前、术后3个月和末次随访时进行腰痛视觉模拟量表（visual analogue scale，VAS）评分、腰椎日本骨科协会（Japanese Orthopedic Association，JOA）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）评定。结果：两组患者均顺利完成手术，未出现明显手术相关并发症。MO-TLIF组与MIS-TLIF组的术中出血量（80.3±25.1mL vs 72.3±21.8mL）、术后切口引流量（30.7±10.2mL vs 29.3±9.0mL）、住院时间（5.4±0.9d vs 5.4±0.8d）等均无统计学差异（P>0.05）。与MIS-TLIF组相比，MO-TLIF组患者手术时间更短（90.8±8.8min vs 98.3±8.0min，P=0.001）、术中透视次数更少（4.7±0.7次 vs 7.2±1.4次，P<0.001）。两组患者术后3个月及末次随访时的腰痛VAS评分、腰椎JOA评分、ODI较术前均有显著性改善（P<0.001），两组间同时间点比较均无统计学差异（P>0.05）。末次随访时两组均未发现断钉、断棒等内固定相关并发症，植骨均融合。结论：双侧MO-TLIF治疗单节段腰椎退变性疾病可取得良好的治疗效果，与MIS-TLIF相比可减少术中透视次数、缩短手术时间。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of bilateral mini-open Wiltse approach transforaminal lumbar interbody fusion(MO-TLIF) in the treatment of degenerative lumbar diseases in the elderly. Methods: A retrospective analysis was conducted on 62 elderly patients with single-segment degenerative lumbar diseases who underwent MO-TLIF or minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) inthe First Affiliated Hospital of Naval Medical University between September 2017 and August 2020. Among them, 37 were male and 25 were female, aged 68.0±5.5 years. The patients were divided into the MO-TLIF group(32 cases) and the MIS-TLIF group(30 cases). There were no statistically significant differences between the two groups in terms of gender ratio, age, body mass index(BMI), surgical segment, disease duration, or follow-up time(P>0.05). The differences between the two groups were compared in terms of operative time, intraoperative blood loss, intraoperative fluoroscopy, postoperative wound drainage, time to ambulation, hospital stay, complications, and fusion rate. The visual analogue scale(VAS), lumbar Japanese Orthopedic Association(JOA) scores, and Oswestry disability index(ODI) before surgery, at 3 months postoperatively, and at the final follow-up were recorded and compared. Results: The two groups of patients all successfully completed the surgery without significant surgery-related complications. There were no statistically significant differences between the MO-TLIF and MIS-TLIF groups in terms of intraoperative blood loss(80.3±25.1mL vs. 72.3±21.8mL), postoperative wound drainage volume(30.7±10.2mL vs. 29.3±9.0mL), or hospital stay(5.4±0.9d vs. 5.4±0.8d)(P>0.05). Compared with the MIS-TLIF group, the MO-TLIF group had shorter operative time(90.8±8.8min vs. 98.3±8.0min, P=0.001) and fewer number of intraoperative fluoroscopy(4.7±0.7 times vs. 7.2±1.4 times, P<0.001). Both groups showed significant improvement in low back pain VAS score, lumbar JOA score, and ODI at postoperative 3 months and final follow-up compared with preoperative values(P<0.001), but there were no statistically significant differences between the two groups at the same time points(P>0.05). At the final follow-up, no internal fixation-related complications such as screw or rod breakage were observed in both groups, and all the cases achieved bone fusion. Conclusions: Bilateral MO-TLIF can achieve good therapeutic outcomes in treating single-segment degenerative lumbar diseases, which can reduce intraoperative fluoroscopy frequency and shorten operative time comparing with MIS-TLIF.