显微镜辅助固定通道下经椎间孔腰椎椎体间融合术治疗双节段腰椎滑脱症的疗效观察

The effect of microscope assisted fixed channel minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of double segment lumbar spondylolisthesis

中文关键词:  显微镜  固定通道  微创经椎间孔腰椎椎体间融合术  双节段腰椎滑脱症  腰椎稳定性  并发症

英文关键词:Microscope  Fixed channel  Minimally invasive transforaminal lumbar interbody fusion surgery  Double segment lumbar spondylolisthesis  Lumbar stability  Complication

中文摘要:

  【摘要】 目的：观察显微镜辅助固定通道下微创经椎间孔腰椎椎体间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）治疗双节段腰椎滑脱症患者的效果，并分析其对腰椎稳定性及并发症的影响。方法：选取我院2022年1月~2024年1月收治的双节段腰椎滑脱症患者108例为研究对象，采用随机数字表法分为常规组（n=53，男29例，女24例，53.23±4.30岁）和显微镜组（n=55，男28例，女27例，53.45±4.28岁）；常规组采用常规固定通道下MIS-TLIF，显微镜组采用显微镜辅助固定通道下MIS-TLIF。两组一般资料具有可比性（P>0.05）。记录并对比两组患者引流量及出血量、透视次数、手术时间及并发症发生情况。于术后6个月采用改良MacNab评分标准评估临床疗效。术前、术后3个月、6个月行X线检查，测量并对比两组患者椎间隙高度及滑脱角水平评估腰椎稳定性情况；同期采用日本骨科协会（Japanese Orthopaedic Association，JOA）评分及Oswestry功能障碍指数（Oswestry disability index，ODI）评估并对比两组患者腰椎功能障碍情况。术前、术后3d及6d通过酶联免疫吸附测定（enzyme-linked immunosorbent assay，ELISA）法检测并对比两组患者C反应蛋白（C-reactive protein，CRP）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、肌酸激酶（creatine kinase，CK）水平进行炎性因子评估。结果：与常规组相比，显微镜组总优良率较高（78.18% vs 60.38%，P<0.05），引流量及出血量、透视次数较少（98.03±9.77mL vs 120.73±13.52mL、113.42±11.03mL vs 142.69±15.72mL、6.71±0.58次 vs 8.36±0.72次，P<0.05）、手术时间较短（123.59±13.58min vs 157.42±16.89min，P<0.05）、并发症发生率较低（3.64% vs 16.98%，P<0.05）。术前，两组椎间隙高度，滑脱角水平、JOA评分及ODI比较无显著统计学差异（P>0.05）；术后椎间隙高度、JOA评分两组均较术前升高，且显微镜组更高（术后3个月：8.03±0.80mm vs 6.12±0.72mm、15.28±1.24分 vs 11.14±1.02分；术后6个月：11.02±1.27mm vs 9.23±0.95mm、21.72±2.14分 vs 18.03±1.60分，P<0.05）；术后滑脱角、ODI两组均降低，且显微镜组更低（术后3个月：2.41°±0.28° vs 3.01°±0.32°、32.14±2.96分 vs 36.01±3.14分；1.60°±0.16° vs 2.03°±0.25°、24.77±2.15分 vs 28.01±2.60分，P<0.05）。术前及术后6d两组CRP、TNF-α、CK水平比较无显著统计学差异（P>0.05）；术后3d，显微镜组CRP、TNF-α、CK水平比常规组低（6.01±0.75mg/L vs 8.23±0.93mg/L、23.01±2.01pg/mL vs 29.36±2.57pg/mL、170.43±19.01U/L vs 205.72±30.89U/L），差异具有统计学意义（P<0.05）。结论：显微镜辅助固定通道下MIS-TLIF在治疗双节段腰椎滑脱症中展现出理想的近期疗效，可降低并发症发生风险；同时能更有效改善患者术后腰椎稳定性，促进腰椎功能恢复，并在术后早期更好地抑制机体炎症反应，具备较高的临床应用价值。

英文摘要:

  【Abstract】 Objectives: To observe the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) under microscope via fixed channel in the treatment of patients with double segment lumbar spondylolisthesis, and analyze its impact on lumbar stability and complications. Methods: 108 patients with bilateral lumbar spondylolisthesis admitted and treated in our hospital from January 2022 to January 2024 were selected as the study subjects in this prospective study. Using a random number table, the patients were divided into two groups: conventional group(n=53, 29 males and 24 females, 53.23±4.30 years old) and microscope group(n=55, 28 males and 27 females, 53.45±4.28 years old). The patients in the conventional group underwent MIS-TLIF via fixed channel through conventional approach, and patients in the microscope group received MIS-TLIF via fixed channel under microscope. There was no significant difference between the two groups in baseline data(P>0.05). The drainage volume and bleeding volume, fluoroscopy frequency, operative time and the occurrence of complications of the two groups of patients were recorded and compared. The clinical efficacy was evaluated using the modified MacNab scoring standard 6 months after operation. X-ray examinations were performed before operation, 3 months and 6 months after operation, and the height of intervertebral space and spondylolisthesis angle were measured and compared to evaluate the stability of the lumbar spine; During the same period, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were used to evaluate and compare the lumbar dysfunction of the two groups of patients. The levels of C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), and creatine kinase(CK) in the two groups of patients were detected and compared by enzyme-linked immunosorbent assay(ELISA) before operation, 3d, and 6d after operation to evaluate inflammatory factors. Results: Compared with the conventional group, the total excellent and good rate of the microscope group was higher(78.18% vs 60.38%, P<0.05), and the drainage and bleeding volume were less(98.03±9.77mL vs 120.73±13.52mL and 113.42±11.03mL vs 142.69±15.72mL, P<0.05), fluoroscopy frequency was fewer(6.71±0.58 vs 8.36±0.72, P<0.05), operative time was shorter(123.59±13.58min vs 157.42±16.89min, P<0.05), and complication rate were lower （3.64% vs 16.98%, P<0.05). Before operation, the intervertebral space height, slip angle, JOA score, and ODI were comparable between the two groups(P>0.05). At 3 and 6 months after operation, the intervertebral space height and JOA score increased, and the microscope group was higher(Postoperative 3 months: 8.03±0.80mm vs 6.12±0.72mm, 15.28±1.24 points vs 11.14±1.02 points; Postoperative 6 months, 11.02±1.27mm vs 9.23±0.95mm, 21.72±2.14 points vs 18.03±1.60 points, P<0.05), while the slip angle and ODI score decreased, and the microscope group was lower(Postoperative 3 months: 2.41°±0.28° vs 3.01°±0.32°, 32.14±2.96 points vs 36.01±3.14 points;Postoperative 6 months: 1.60°±0.16° vs 2.03°±0.25°, 24.77±2.15 points vs 28.01±2.60 points, P<0.05). Before operation and on 6d after operation, the levels of CRP, TNF-α, and CK were comparable between the two groups(P>0.05); 3d after operation, the levels of CRP, TNF-α and CK in the microscope group were lower(6.01±0.75mg/L vs 8.23±0.93mg/L, 23.01±2.01pg/mL vs 29.36±2.57pg/mL, 170.43±19.01U/L vs 205.72±30.89U/L, P<0.05). Conclusions: Microscopically-assisted MIS-TLIF demonstrates excellent short-term efficacy in treating two-segment lumbar spondylolisthesis, which can significantly reduce complication risks. It effectively enhances postoperative lumbar stability, promotes functional recovery, and suppresses early inflammatory responses, making it a clinically valuable treatment option.