前外侧腰椎间融合术与后路经椎间孔腰椎间融合术治疗L4/5 Ⅰ度退变性腰椎滑脱的疗效比较

Anterolateral lumbar interbody fusion vs transforaminal lumbar interbody fusion in L4/5 degree Ⅰ degenerative spondylolisthesis

中文关键词:  退变性腰椎滑脱症  前外侧腰椎间融合术  后路经椎间孔腰椎间融合术  疗效

英文关键词:Degenerative spondylolisthesis  Anterolateral lumbar interbody fusion  Transforaminal lumbar interbody fusion  Efficacy

中文摘要:

  【摘要】 目的：比较单纯前外侧腰椎间融合术（anterolateral lumbar interbody fusion，ALLIF）与后路经椎间孔腰椎间融合术（transforaminal lumbar interbody fusion，TLIF）治疗Ⅰ度退变性腰椎滑脱的疗效。方法：回顾2013年4月～2015年4月在我院行手术治疗的68例L4/5　Ⅰ度退变性腰椎滑脱患者，其中32例行ALLIF，男20例，女12例，年龄51.3±11.9岁（40～65岁）；36例行TLIF，男22例，女14例，年龄50.3±8.６岁（42～63岁）。对两组患者的一般资料、围手术期参数、并发症、术前和术后1周、6个月、12个月、24个月的腰痛和腿痛视觉模拟评分（visual analog scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）和影像学参数[腰椎前凸（ＬＬ）、手术节段椎间高度（ＤＨ）、手术节段前凸角（ＳＬＡ）和滑脱百分比（Slip%）]进行比较分析。结果：两组患者的年龄、性别比、体重指数、骨盆指数、术前腰腿痛ＶＡＳ评分、ＯＤＩ、影像学参数和随访时间等均无统计学差异（P>0.05）。ALLIF组手术时间和出血量分别为69.97±11.06min和133.40±23.71ml，TLIF组分别为106.42±8.47min和249.48±30.16ml，ALLIF组均显著性低于TLIF组（P<0.05）。术中未出现大血管损伤、硬膜撕裂、神经功能损害、腹膜撕裂、腹部脏器损伤，术后无切口疝、内固定或假体松动、断裂等并发症。两组术后各时间点的腰痛VAS评分、腿痛VAS评分、ODI均较术前有明显改善（P<0.05），两组间同时间点比较均无显著性差异（P>0.05）。两组术后各时间点的DH、LL、SLA、Slip%均较术前有显著性改善（P<0.05），两组术后各个时间点的Slip%比较均无显著性差异（P>0.05），ALLIF组术后各个时间点的DH、LL、SLA均优于同时间点TLIF组（P<0.05）。末次随访时两组患者均获骨性融合，ALLIF组5例（15.6%）出现融合器沉降。结论：与TLIF相比，ALLIF治疗Ⅰ度退行性腰椎滑脱同样可以获得满意的临床疗效，并具有手术出血量少、手术时间短，可以更好地恢复椎间隙高度以及腰椎前凸角的优势。

英文摘要:

  【Abstract】 Objectives: To compare the efficacy of anterolateral lumbar interbody fusion(ALLIF) and transforaminal lumbar interbody fusion(TLIF) in L4/5 degree Ⅰ degenerative spondylolisthesis. Methods: Six-eight patients with L4/5 degree Ⅰ degenerative spondylolisthesis who underwent surgical treatment from April 2013 to April 2015 were reviewed, including 32 patients(20 males and 12 females) undergoing ALLIF with age of 51.5±11.9(range, 40-65 years old) and 36 patients(22 males and 14 females) undergoing TLIF with age of 50.3±8.6(range, 42-63 years old). The following were recorded: demographic details, perioperative complications, visual analog scale(VAS) scores of leg and back, the Oswestry disability index(ODI) scores. Radiographic outcomes before surgery, at 1 week, 6 months, 12 months and 24 months after surgery were measured: fusion rate, cage subsidence, lumbar lordosis(LL), disc height(DH), segmental lordotic angle(SLA) and the percentage of slip(SLIP%). Results: There were no statistical differences in age, sex ratio, body mass index(BMI), preoperative VAS scores of low back and leg, radiographic outcomes and follow-up time between the two groups(P>0.05). The mean operation time and blood loss in group ALLIF were significantly less than those in group TLIF(106.42±8.47ml vs. 249.48±30.16ml, P＜0.05; 69.98±11.06min vs 133.4±23.7min, P＜0.05). There was no vessel injury, dural tear, neurological deficit, peritoneal tear, abdominal organ injury, incision hernia, implant loosening or fracture, or other complication in both groups. The postoperative VAS back pain, VAS leg pain and ODI at each follow-up time point were significantly improved(P<0.05) in both groups. The VAS back pain, VAS leg pain and ODI score at each follow-up time point between the two groups were not statistically different(P>0.05). The postoperative DH, LL, ILA and Slip% in both groups were significantly improved when compared to the preoperative data(P<0.05). The Slip% between the two groups at each follow-up time point was not significantly different(P>0.05). The postoperative DH, LL, SLA in group ALLIF were better than those in group TLIF at each follow-up time point(P<0.05). Bony fusion was achieved in all the patients of two groups at the final follow-up. There were 5 cases(15.6%) of subsidence without symptom in group ALLIF. Conclusions: ALLIF and TLIF can achieve satisfactory clinical efficacy in L4/5 degree Ⅰ degenerative spondylolisthesis. ALLIF has less blood loss and shorter operation time than TLIF surgery, and it can better restore the height of intervertebral space and lumbar lordosis. ALLIF can be an alternative treatment of degenerative spondylolisthesis in strictly selected cases.