| 潘玺宇,朱辰蕾,张俊,等.经椎间隙撑开复位TLIF与传统TLIF治疗Ⅱ度及以上腰椎滑脱合并骨质疏松的对比研究.骨科,2025,16(5): 392-398. |
| 经椎间隙撑开复位TLIF与传统TLIF治疗Ⅱ度及以上腰椎滑脱合并骨质疏松的对比研究 |
| Comparative study of TLIF with intervertebral distraction reduction and traditional TLIF for the treatment of lumbar spondylolisthesis of grade Ⅱ or above complicated with osteoporosis |
| 投稿时间：2025-05-06 |
| DOI：10.3969/j.issn.1674-8573.2025.05.002 |
| 中文关键词: 经椎间隙撑开复位 腰椎滑脱 骨质疏松 经椎间孔腰椎椎体间融合术 |
| 英文关键词: Intervertebral distraction reduction Lumbar spondylolisthesis Osteoporosis Transforaminal lumbar interbody fusion |
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| 中文摘要: |
| 目的 对比传统经椎间孔腰椎椎体间融合术（TLIF）与经椎间隙撑开复位TLIF治疗Ⅱ度及以上腰椎滑脱合并骨质疏松病人的临床疗效。方法 回顾性分析2015年10月至2023年6月在我院接受经椎间隙撑开复位TLIF手术或传统TLIF手术的中重度腰椎滑脱伴骨质疏松病人90例，其中采用经椎间隙撑开复位TLIF的42例病人纳入椎间隙组，采用传统TLIF的48例病人纳入传统组。比较两组病人术前、术后即刻及术后1年随访时脊柱影像学参数［椎间隙前凸角（IL）、腰椎前凸角（LL）、椎间隙高度（IH）、椎间孔高度（FH）、滑脱率］、融合器沉降值及沉降率，以及疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）。结果 两组病人均顺利完成手术，并随访1年以上。椎间隙组出血量显著高于传统组［（299.76±97.60） mL vs. （245.63±54.10） mL］；术后即刻椎间隙组的IH、FH、LL、IL分别为（10.24±2.05） mm、（15.08±2.66） mm、50.41°±6.19°、12.86°±3.11°，显著高于传统组，术后滑脱率显著低于传统组（9.38%±3.18% vs. 15.73%±6.60%）；术后1年随访时，椎间隙组的IH、FH、LL、IL分别为（9.49±2.09） mm、（14.50±2.46） mm、49.75°±6.38°、11.20°±3.46°，同样显著高于传统组，滑脱率显著低于传统组（9.81%±3.22% vs. 17.31%±6.56%）；而且，椎间隙组的融合器沉降值和沉降率显著低于传统组［（0.33±0.21） mm vs. （0.75±0.42） mm，3.24%±1.78% vs. 8.33%±4.44%］；差异均有统计学意义（P＜0.05）。两组并发症发生率分别为4.76%、8.33%，差异无统计学意义（P＞0.05）。结论 与传统TLIF相比，经椎间隙撑开复位TLIF治疗合并骨质疏松的Ⅱ度及以上腰椎滑脱可以更有效地恢复LL及IH、减少椎间融合器的沉降，内固定并发症发生率低，具有良好的临床疗效。 |
| 英文摘要: |
| Objective To compare the clinical effect of transforaminal lumbar interbody fusion (TLIF) with intervertebral distraction reduction and traditional TLIF in the treatment of patients with grade Ⅱ or above lumbar spondylolisthesis combined with osteoporosis. Methods A retrospective analysis was conducted on 90 patients with lumbar spondylolisthesis combined with osteoporosis who underwent TLIF with intervertebral distraction reduction or traditional TLIF surgery in our hospital from October 2015 to June 2023. Among them, 42 patients who underwent TLIF with intervertebral distraction reduction were included in the intervertebral group, and 48 patients who underwent traditional TLIF were included in the traditional group. The spinal imaging parameters such as intervertebral lordosis (IL), lumbar lordosis (LL), intervertebral height (IH), foramen height (FH), skip degree, and the subsidence value and subsidence rate, as well as visual analogue scale (VAS) scores and Oswestry Disability Index (ODI) of the two groups were compared preoperation, immediately postoperation and at 1-year follow-up. Results Both groups successfully completed the surgery and were followed up for more than one year. The amount of bleeding in the intervertebral group was significantly greater than that in the traditional group ［(299.76±97.60) mL vs. (245.63±54.10) mL］. Immediately after the operation, the IH, FH, LL, IL in the intervertebral group were (10.24±2.05) mm, (15.08±2.66) mm, 50.41°±6.19°, and 12.86°±3.11° respectively, which were significantly higher than those in the traditional group, and the postoperative skip degree was significantly lower than that in the traditional group (9.38%±3.18% vs. 15.73%±6.60%). At the one-year follow-up, the IH, FH, LL, IL in the intervertebral group were (9.49±2.09) mm, (14.50±2.46) mm, 49.75°±6.38°, and 11.20°±3.46°, respectively, which were still significantly higher than those in the traditional group, and the skip degree was significantly lower than that in the traditional group (9.81%±3.22% vs. 17.31%±6.56%). Moreover, the subsidence value and subsidence rate in the intervertebral group were significantly lower than those in the traditional group ［(0.33±0.21) mm vs. (0.75±0.42) mm, 3.24%±1.78% vs. 8.33%±4.44%］. All differences were statistically significant (P＜0.05). The complication rates of the two groups were 4.76% and 8.33%, respectively, and the difference was not statistically significant (P＞0.05). Conclusion Compared with traditional TLIF, TLIF with intervertebral distraction reduction can more effectively restore LL and LH, reduce the subsidence of intervertebral fusion devices, with low incidence of internal fixation complications, presenting good clinical efficacy in treatment of grade II and above lumbar spondylolisthesis with osteoporosis. |
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