经多裂肌间隙入路改良TLIF手术治疗成人峡部裂性腰椎滑脱症研究(1)
[摘要] 目的 研究经多裂肌间隙入路改良经椎间孔腰椎椎体间融合术(Transforaminal Lumbar Interbody Fusion，TLIF)治疗成人峡部裂性腰椎滑脱症的疗效。方法 方便筛选该院2016年6月—2018年6月收治的20例成人峡部裂性腰椎滑脱症患者，均接受经多裂肌间隙入路改良TLIF手术治疗，术后随访12个月，分析其所取得的疗效。结果 20例患者总有效率100.00%、并发症发生率0.00%;术后疼痛评分、日本骨科协会评估治疗分数(JOA)、腰椎活动度(前屈、后伸、侧屈、旋转)分别为(0.85±0.20)分、(28.00±1.00)分、(87.24±1.36)°、(27.55±1.15)°、(27.80±1.22)°、(88.10±1.15)°，与术前(4.45±1.05)分、(12.50±1.50)分、(45.55±1.35)°、(12.40±1.20)°、(10.35±1.25)°、(38.50±1.50)°相比较，差异有统计学意义(t=18.934、54.378、59.680、33.245、40.321、78.851，P<0.05)。结论 經多裂肌间隙入路改良TLIF手术治疗成人峡部裂性腰椎滑脱症疗效确切。
[关键词] 成人峡部裂性腰椎滑脱症;经多裂肌间隙入路;经椎间孔腰椎椎体间融合术
[中图分类号] R816.8 [文献标识码] A [文章编号] 1674-0742(2020)07(a)-0038-04
[Abstract] Objective To study the effect of Transforaminal Lumbar Interbody Fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis through the transforaminal space approach. Methods Convenient screening 20 adult patients with isthmic fissure spondylolisthesis from June 2016 to June 2018 in the hospital， all received modified TLIF surgery through the multifissure space approach. Follow-up was performed for 12 months after operation to analyze the effect obtained. Results The total effective rate of 20 patients was 100.00%， and the complication rate was 0.00%. Postoperative pain score， Japanese Orthopaedic Association Score(JOA)， and lumbar spine mobility (anterior flexion， posterior extension， lateral flexion， rotation) were (0.85±0.20)points and (28.00±1.00)points， (87.24±1.36)°， (27.55±1.15)°， (27.80±1.22)°， (88.10±1.15)°， compared with preoperative (4.45±1.05) points， (12.50±1.50) points， (45.55±1.35)°， (12.40±1.20)°， (10.35±1.25)°， (38.50±1.50)°， the difference was statistically significant (t=18.934， 54.378， 59.680， 33.245， 40.321， 78.851， P<0.05). Conclusion The modified TLIF operation through the multifidus intermuscular approach is effective in the treatment of adult isthmic fissure spondylolisthesis.
[Key words] Adult isthmic fissure lumbar spondylolisthesis; Approach through the multifidus muscle space; Transforaminal lumbar interbody fusion
成人峡部裂性腰椎滑脱症已经成为临床中常见的病症类型，并且属于下腰痛的主要病因之一[1]。由于成人峡部裂性腰椎滑脱症患者普遍伴有不同程度的疼痛及功能障碍，严重影响其生活质量，保守治疗往往难以取得预期效果，故手术成为其首选治疗手段，TLIF在以往临床中较为常用且疗效值得肯定，但在实施过程中容易给神经带来不良影响且减压效果不佳，故临床对该术式进行了改良，形成改良TLIF[2]。经多裂肌间隙入路是近些年来涌现出来的手术入路方案，在腰椎滑脱治疗中取得了较为理想的疗效[3]。然而，目前经多裂肌间隙入路与改良TLIF手术联合应用的报道较少，故该次研究方便选取该院2016年6月—2018年6月收治的20例成人峡部裂性腰椎滑脱症患者为研究对象，分析经多裂肌间隙入路改良TLIF手术取得的临床疗效，以为该术式在今后该类患者临床治疗中推广使用积累经验，报道如下。, http://www.100md.com(肖州 陈志亮 阮肇祯 陆桂生 江海亮)
[关键词] 成人峡部裂性腰椎滑脱症;经多裂肌间隙入路;经椎间孔腰椎椎体间融合术
[中图分类号] R816.8 [文献标识码] A [文章编号] 1674-0742(2020)07(a)-0038-04
[Abstract] Objective To study the effect of Transforaminal Lumbar Interbody Fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis through the transforaminal space approach. Methods Convenient screening 20 adult patients with isthmic fissure spondylolisthesis from June 2016 to June 2018 in the hospital， all received modified TLIF surgery through the multifissure space approach. Follow-up was performed for 12 months after operation to analyze the effect obtained. Results The total effective rate of 20 patients was 100.00%， and the complication rate was 0.00%. Postoperative pain score， Japanese Orthopaedic Association Score(JOA)， and lumbar spine mobility (anterior flexion， posterior extension， lateral flexion， rotation) were (0.85±0.20)points and (28.00±1.00)points， (87.24±1.36)°， (27.55±1.15)°， (27.80±1.22)°， (88.10±1.15)°， compared with preoperative (4.45±1.05) points， (12.50±1.50) points， (45.55±1.35)°， (12.40±1.20)°， (10.35±1.25)°， (38.50±1.50)°， the difference was statistically significant (t=18.934， 54.378， 59.680， 33.245， 40.321， 78.851， P<0.05). Conclusion The modified TLIF operation through the multifidus intermuscular approach is effective in the treatment of adult isthmic fissure spondylolisthesis.
[Key words] Adult isthmic fissure lumbar spondylolisthesis; Approach through the multifidus muscle space; Transforaminal lumbar interbody fusion
成人峡部裂性腰椎滑脱症已经成为临床中常见的病症类型，并且属于下腰痛的主要病因之一[1]。由于成人峡部裂性腰椎滑脱症患者普遍伴有不同程度的疼痛及功能障碍，严重影响其生活质量，保守治疗往往难以取得预期效果，故手术成为其首选治疗手段，TLIF在以往临床中较为常用且疗效值得肯定，但在实施过程中容易给神经带来不良影响且减压效果不佳，故临床对该术式进行了改良，形成改良TLIF[2]。经多裂肌间隙入路是近些年来涌现出来的手术入路方案，在腰椎滑脱治疗中取得了较为理想的疗效[3]。然而，目前经多裂肌间隙入路与改良TLIF手术联合应用的报道较少，故该次研究方便选取该院2016年6月—2018年6月收治的20例成人峡部裂性腰椎滑脱症患者为研究对象，分析经多裂肌间隙入路改良TLIF手术取得的临床疗效，以为该术式在今后该类患者临床治疗中推广使用积累经验，报道如下。, http://www.100md.com(肖州 陈志亮 阮肇祯 陆桂生 江海亮)