文章摘要
李勇,徐勇,高放,郜德龙,吴巍,关邯峰,廖晖,熊伟,方忠,李锋.Wiltse入路经椎间孔椎体间融合术治疗腰椎滑脱症的疗效分析.骨科,2019,10(1):1-7
Wiltse入路经椎间孔椎体间融合术治疗腰椎滑脱症的疗效分析
Clinical analysis of transforaminal lumbar interbody fusion technique via Wiltse approach in the treatment of lumbar spondylolisthesis
投稿时间:2018-10-12  
DOI:10.3969/j.issn.1674-8573.2019.01.001
中文关键词: 腰椎滑脱症  经椎间孔椎体间融合术  Wiltse入路  疗效分析
英文关键词: Lumbar spondylolisthesis  Transforaminal lumbar interbody fusion  Wiltse approach  Therapeutic effect
基金项目:国家重点研发计划(2016YFB1101300);国家自然科学基金资助项目(81601611)
作者单位E-mail
李勇 华中科技大学同济医学院附属同济医院骨科武汉 430030  
徐勇 华中科技大学同济医学院附属同济医院骨科武汉 430030  
高放 华中科技大学同济医学院附属同济医院骨科武汉 430030  
郜德龙 华中科技大学同济医学院附属同济医院骨科武汉 430030  
吴巍 华中科技大学同济医学院附属同济医院骨科武汉 430030  
关邯峰 华中科技大学同济医学院附属同济医院骨科武汉 430030  
廖晖 华中科技大学同济医学院附属同济医院骨科武汉 430030  
熊伟 华中科技大学同济医学院附属同济医院骨科武汉 430030  
方忠 华中科技大学同济医学院附属同济医院骨科武汉 430030 zhongfangtjh@yahoo.com 
李锋 华中科技大学同济医学院附属同济医院骨科武汉 430030 lifengmd@hust.edu.cn 
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中文摘要:
      目的 探讨Wiltse入路经椎间孔椎体间融合术(transforaminal lumbar interbody fusion, TLIF)治疗腰椎滑脱症的疗效。方法 回顾性分析2015年1月至2017年1月我院收治并获得随访的83例采用Wiltse入路TLIF技术治疗的腰椎滑脱病例。其中,男35例,女48例;年龄为(52.4±8.5)岁(33~75岁)。①记录病人手术时间、术中出血量及并发症等情况;②收集术前及末次随访时的腰痛和下肢痛的疼痛视觉模拟量表(visual analogue scale, VAS)评分和Oswestry功能障碍指数(Oswestry disability index, ODI);③通过观察影像学资料,测量椎间隙高度、椎间隙前凸角和腰椎前凸角,统计滑脱率。结果 ①本组手术时间为(135.0±15.7) min,术中出血量为(297.8±63.6) ml,术后随访时间为(28.6±6.7)个月(18~40个月),5例出现术后脑脊液漏,1例出现神经损伤,1例出现硬膜外血肿,2例发生浅表感染,1例出现深部感染。②腰痛VAS评分、下肢痛VAS评分及ODI分别由术前的(6.5±1.8)分、(5.0±3.0)分和59.7%±12.7%下降至末次随访时的(2.0±1.0)分、(1.4±1.2)分和19.5%±5.5%,差异均有统计学意义(P均<0.001)。③滑脱率由术前的21.4%±4.0%下降至末次随访时的7.3%±2.1%,椎间隙高度、椎间隙前凸角和腰椎前凸角分别由术前的(7.0±1.8) mm、3.0°±1.2°、38.5°±7.5°提高至末次随访时的(9.8±1.6) mm、5.2°±1.0°、41.3°±7.1°,差异均有统计学意义(P均<0.001)。结论 经Wiltse入路TLIF技术能有效治疗腰椎滑脱症,对于恢复腰椎序列、缓解疼痛、功能改善是安全、可行、有效的。
英文摘要:
      Objective To explore the curative effect of transforaminal lumbar interbody fusion (TLIF) technique via the Wiltse approach in the treatment of lumbar spondylolisthesis. Methods A retrospective analysis on 83 patients with lumbar spondylolisthesis treated by TLIF via the Wiltse approach from January 2015 to January 2017 was made. Among them, there were 35 males and 48 females with the average age of (52.4±8.5) years (33-75 years). During the surgical operation, intraoperative blood loss and complications of patients were recorded. Visual analogue scale (VAS) scores of low back pain and lower limb pain and Oswestry disability index (ODI) were collected before operation and at the last follow-up. The height of intervertebral space, lumbar lordosis angle and lumbar lordosis angle were measured and the slippage rate was counted by observing the imaging data. Results The operation time was (135.0±15.7) min and the amount of bleeding was (297.8±63.6) ml. The follow-up time was (28.6±6.7) months (18-40 months). There were 5 cases of postoperative cerebrospinal fluid leakage, 1 case of nerve damage, 1 case of epidural hematoma, 2 cases of superficial infection and 1 case of deep infection. The VAS score of low back pain and lower limb pain and ODI decreased from 6.5±1.8, 5.0±3.0 and 59.7%±12.7% before operation to 2.0±1.0, 1.4±1.2 and 19.5%±5.5% at the last follow-up, respectively, and all the differences were statistically significant (all P<0.001). The mean slip rate decreased from 21.4%±4.0% preoperatively to 7.3%±2.1% at the last follow-up, the preoperative intervertebral disc height (7.0±1.8) mm, segment lordosis angle was 3.0°±1.2° and lumbar lordosis angle 38.5°±7.5° increased to (9.8±1.6) mm, 5.2°±1.0° and 41.3°±7.1° at the last follow-up, respectively, and all the differences were statistically significant (all P<0.001). Conclusion TLIF via the Wiltse approach can effectively treat lumbar spondylolisthesis. It is safe, feasible and effective for restoring lumbar spine sequence, relieving pain and improving function.
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