摘要目的 探讨双侧管状通道下微创经椎间孔腰椎间融合术(MIS-TLIF)治疗单节段腰椎滑脱症的临床疗效.方法 回顾性分析同济大学附属同济医院脊柱外科2014年10月至2015年11月对21例腰椎滑脱症患者施行双侧管状通道下MIS-TLIF的临床资料.21例患者中,男性11例,女性10例,年龄35～82岁,平均年龄60.7岁;滑脱类型:退变性滑脱18例,峡部裂性滑脱3例;滑脱程度:Ⅰ°滑脱17例,Ⅱ°滑脱4例;滑脱节段:L4-5滑脱17例,L5-S1滑脱4例.记录患者手术时间、术中出血量、术后引流量以及术中射线暴露时间;术前、术后3个月和末次随访时,以视觉模拟量表评分(VAS)评估患者腰痛及腿痛的程度,以Oswestry功能障碍指数(ODI)评估患者功能改善情况;测量椎间隙平均高度、腰椎Cobb角和手术节段Cobb角、腰椎滑脱指数,评价椎间孔恢复及腰椎矢状位曲度改变情况.末次随访时,以Siepe评价标准评估椎间融合情况,以MacNab量表评估临床治疗效果.手术前后影像学与功能学的比较使用配对t检验,以P＜0.05为差异有统计学意义.结果 所有病例均顺利完成手术,手术时间(235.2±30.2)min,术中出血量(238.1±130.3) ml,术后引流量(95.7±57.])ml,术中射线暴露(47.1±8.8)次.统计学结果显示,术后3个月与术前相比,腰痛VAS(t=11.1,P＜0.01)、腿痛VAS(t=17.8,P＜0.01),差异均具有统计学意义(P值均＜0.01);末次随访时与术前相比,腰痛VAS(t =21.9,P＜0.01)、腿痛VAS(t=22.2,P＜0.01)、ODI(t=30.1,P＜0.01),差异均具有统计学意义(P值均＜0.01);末次随访时与术后3个月相比,腰痛VAS(t=10.5,P＜0.01)、腿痛VAS(t=5.4,P＜0.01),差异均具有统计学意义(P值均＜0.01).术后3个月与术前相比,椎间隙平均高度(t=-10.9,P＜0.01)、腰椎Cobb(t=2.4,P＜0.05)及手术节段Cobb(t=-5.2,P＜0.01)、腰椎滑脱率(t=17.1,P＜0.01),差异均具有统计学意义(P值均＜0.05);末次随访时与术前相比,椎间隙平均高度(t=-10.5,P＜0.01)、腰椎Cobb(t=-2.7,P=0.01)及手术节段Cobb(t=-4.2,P＜0.01)、腰椎滑脱率(t=18.6,P＜0.01),差异均具有统计学意义(P值均＜0.05),腰椎滑脱获得复位.末次随访时,按照Siepe评价标准评估,1级12例、2级7例;按照MacNab量表评估,优17例,良3例,可1例.结论 双侧管状通道下MIS-TLIF治疗单节段腰椎滑脱症安全、有效.

abstractsObjective To evaluate the clinical effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar spondylolisthesis treatment with bilateral Spotlight tubular channels.Methods A total of 21 patients with lumbar spondylolisthesis whom underwent MIS-TLIF via bilateral Spotlight tubular channels were retrospectively analyzed from October 2014 to November 2015.The 21 patients included 11 males and 10 females ranged from 35 to 82 years (average aged 60.7 years).In term of spondylolisthesis category,there were 18 cases of degenerative spondylolisthesis and 3 cases of isthmic spondylolisthesis.With respect to spondylolisthesis degree,17 cases were grade Ⅰ ° and 4 cases were grade Ⅱ °.Besides,17 cases at L4-5 and 4 cases at L5-S1 were categorized by spondylolisthesis levels.Operation duration,blood loss,postoperative drainage and intraoperative exposure time were recorded,functional improvement was defined as an improvement in the Oswestry Disability Index (ODI),Visual Analog Scale (VAS) was also employed at pre and post-operation (3 months and the last follow-up),to evaluate low back and leg pain.Furthermore,to evaluate the recovery of the intervertebral foramen and of lumbar sagittal curvature,average height of intervertebral space,Cobb angles of lumbar vertebrae and operative segments,spondylolisthesis index were measured.At the last follow-up,intervertebral fusion was assessed using Siepe evaluation criteria and the clinical outcome was assessed using the MacNab scale.Radiographic and functional outcomes were compared pre-and postoperation using the paired T test to determine the effectiveness of MIS-TLIF.Statistical significance was defined as P＜0.05.Results All patients underwent a successful MIS-TLIF surgery.The operation time (235.2± 30.2) mins,intraoperative blood loss (238.1 ± 130.3) ml,postoperative drainage (95.7 ± 57.1) ml and intraoperative radiation exposure (47.1±8.8) were recorded.Different significance between 3 months post-operative follow-up and pre-operation was exhibited (P＜0.01) in respects of lumbar VAS (t=11.1,P＜0.01) and leg VAS (t =17.8,P＜0.01).Moreover,final follow-up compared with pre operation,and final follow-up compared with 3 months post-operative follow-up,VAS scores were also statistical difference (P＜0.01).At the final follow-up,there were significant differences compared with pre operation in ODI scores (t=30.1,P＜0.01).Comparison between 3 months post-operative follow-up and pre-operation,statistical distinctions were demonstrated (P＜0.05) in terms of mean height of intervertebral space (t=-10.9,P＜0.01),the Cobb angles of lumbar vertebrae (t=-2.4,P＜0.05),operative segments Cobb angles (t =-5.2,P＜ 0.01) and Lumbar spondylolisthesis incidence (t =17.1,P＜ 0.01).In addition,there was statistical difference between final follow-up and pre-operation (P＜0.05) as well.For instance,mean height of intervertebral space (t =-10.5,P＜0.01),the Cobb angles of lumbar vertebrae (t=-2.7,P＜0.05),operative segments Cobb angles (t =-4.2,P＜0.01) and Lumbar spondylolisthesis incidence (t =18.6,P＜0.01) were involved.All spondylolisthesis vertebrae were restored completely.Lastly,at the last follow-up,12 cases of grade 1 and 7 cases of grade 2 fusion were present as determined by the Siepe evaluation criteria.McNab scale assessment classified 17 patients having excellent clinical outcome,3 patients in good and 1 patient having a better clinical outcome.Conclusion MIS-TLIF with bilateral Spotlight tubular channels is a safe and effective approach for single segment lumbar spondylolisthesis.