改良经皮经椎间孔腰椎椎体间融合术治疗腰椎退行性疾病的疗效分析

Clinical efficacy analysis of modified percutaneous transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases

中文关键词:  腰椎退行性疾病  改良经皮经椎间孔腰椎椎体间融合术  微创脊柱外科

英文关键词:Lumbar degenerative diseases  Modified percutaneous transforaminal lumbar interbody fusion  Minimally invasive spine surgery

中文摘要:

  【摘要】 目的：分析改良经皮经椎间孔腰椎椎体间融合术（modified percutaneous transforaminal lumbar interbody fusion, MPTLIF）治疗腰椎退行性疾病的早期临床疗效。方法：回顾性分析2020年1月~2021年10月在陆军军医大学附属第二医院接受MPTLIF治疗的26例腰椎退行性疾病患者的临床资料，其中男性12例，女性14例；年龄44~77岁（58.3±8.4岁）；腰椎滑脱症16例，腰椎不稳伴神经根管狭窄症10例；L3/4 3例，L4/5 23例。统计患者手术时间、术中出血量、术后住院时间和术后引流量，术前、术后3d、术后3个月和末次随访时进行疼痛视觉模拟评分（visual analogue scale，VAS），术前、术后3个月和末次随访时行Oswestry功能障碍指数（Oswestry disability index，ODI）评定，末次随访时采用改良MacNab疗效评定标准评价临床疗效。在术前和末次随访时的X线片和CT片上测量椎间隙前后缘高度、腰椎前凸角和手术节段前凸角。结果：所有患者均顺利完成手术，手术时间98.9±6.6min，术中出血量41.0±12.6mL，术后引流量38.1±9.5mL，术后平均住院时间3.8±0.9d，无硬膜外血肿、感染或肌肉麻痹瘫痪等并发症。随访17.7±4.2个月，术前和术后3d、术后3个月和末次随访时的VAS评分分别为5.85±0.67分、2.15±0.54分、1.12±0.33分、0.54±0.51分，术前、术后3个月和末次随访时的ODI分别为 （47.38±6.66）％、（11.73±6.73）％、（6.58±6.51）％，术后各时间点的VAS评分和ODI与术前比较均显著性改善（P<0.05），且随着术后时间推移有进一步改善（P<0.05）；末次随访时改良MacNab 疗效评定标准评定优24例，良2例。末次随访时椎间隙前后缘高度（前缘10.95±1.24mm、后缘9.45±1.13mm）、腰椎前凸角（47.38°±4.56°）和手术节段前凸角（8.62°±1.92°）均较术前（前缘8.85±1.00mm、后缘6.78±1.07mm、43.81°±4.85°、6.62°±2.02°）有显著性改善（P<0.05）。结论：对严格适应证选择的病例，MPTLIF是一种安全、有效的微创治疗术式，治疗腰椎退行性疾病能够获得良好的早期临床疗效。

英文摘要:

  【Abstract】 Objectives: To analyze the early clinical efficacy of modified percutaneous transforaminal lumbar interbody fusion(MPTLIF) in the treatment of lumbar degenerative diseases. Methods: The clinical data of 26 patients who underwent MPTLIF at the Second Affiliated Hospital of Army Medical University between January 2020 and October 2021 were analyzed retrospectively. There were 12 males and 14 females, aged 44-77 years(58.3±8.4 years); Lumbar spondylolisthesis in 16 cases, lumbar spinal instability with radicular stenosis in 10 cases; 3 cases were of L3/4 and 23 cases were of L4/5. The operative time, intraoperative bleeding, postoperative hospital stay, and postoperative drainage were analyzed. The visual analogue scale(VAS) for pain was documented before operation, at 3d and 3 months after operation and at the final follow-up, the Oswestry disability index(ODI) was used for evaluation before operation, at 3 months and the final follow-up after operation, and the modified MacNab efficacy evaluation criteria were used to evaluate the clinical efficacy at the final follow-up. The anteroposterior height of the intervertebral space, lumbar lordosis angle, and lordosis angle of the operated segment were measured on X-ray and CT images before surgery and at the final follow-up. Results: All the patients successfully underwent the operation with an operative time of 98.9±6.6min, intraoperative bleeding of 41.0±12.6mL, postoperative drainage of 38.1±9.5mL, and an average postoperative hospital stay of 3.8±0.9d without complications such as epidural hematoma, infection, or muscle paralysis and paralysis. The follow-up time was 17.7±4.2 months, and the VAS scores preoperatively, 3d postoperatively, 3 months postoperatively, and at final follow-up were 5.85±0.67, 2.15±0.54, 1.12±0.33, 0.54±0.51, respectively. The ODI were (47.38±6.66)%, (11.73±6.73)%, and (6.58±6.51)% before operation, at 3 months and the final follow-up, respectively. The VAS scores and ODI at all time points after operation significantly improved compared with the preoperative values(P<0.05), and which improved over time(P<0.05). At final follow-up, according to the modified MacNab criteria, 24 cases were evaluated as excellent and 2 cases were evaluated as good. The anteroposterior height of the intervertebral space(anterior edge 10.95±1.24mm, posterior edge 9.45±1.13mm), lumbar lordosis(47.38°±4.56°) and lordosis angle of the operated segment(8.62°±1.92°) were higher at final follow-up than before operation(anterior edge 8.85±1.00mm, posterior edge 6.78±1.07mm, 43.81°±4.85°, 6.62°±2.02°), with significant improvement(P<0.05). Conclusions: MPTLIF is a safe and effective minimally invasive procedure for the treatment of lumbar degenerative disease in cases selected for strict indications, which can achieve great early clinical efficacy.