Wang Jian, Zhou Yue, Zhang Zheng-feng, Li Chang-qing, Ren Xian-jun, Chu Tong-wei, Wang Wei-dong, Zheng Wen-jie, Pan Yong, Huang Bo
Department of Orthopaedics, Affiliated Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
Zhonghua Wai Ke Za Zhi. 2011 Dec;49(12):1076-80.
To retrospectively analyze the treatment of lumbar spondylolisthesis using minimally invasive and open transforaminal lumbar interbody fusion (TLIF), and compare the clinical results of two techniques.
From June 2006 to May 2010, 371 patients with lumbar spondylolisthesis grade 1 and 2 were treated with TLIF, pedicle screw fixation and followed up. The mean age was 50.4 years (range, 37 - 85 years). There were 172 patients who underwent minimally invasive TLIF and percutaneous pedicle screw fixation were set as the MIS-TLIF group, 199 patients who underwent open TLIF and pedicle screw fixation were set as the OTLIF group. The operative time, blood loss, X-ray exposure time and complications were compared between the two groups. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index (ODI). Fusion rates were determined by using CT scan reconstruction and dynamic lumbar radiography in last fellow-up.
The average follow-up duration was 32.7 months with a range of 12-58 months. The gender, age, classification of spondylolisthesis and level of fusion showed a identical pattern in both groups. The mean intra-operative blood loss (310 ± 75) ml and postoperative blood loss (38 ± 13) ml in MIS-TLIF group were significantly superior to the intra-operative blood loss (623 ± 156) ml and postoperative blood loss (184 ± 72) ml in OTLIF group (t = 2.836 and 3.274, P < 0.01). Comparing with the OTLIF group (20 ± 10) s, the MIS-TLIF group had a significantly longer radiation time (51 ± 19) s (t = 2.738, P < 0.01). There was no statistical difference in operating time, lower back pain VAS scores, ODI scores and incidence of complication between the two groups.
Comparing with open TLIF, minimally invasive TLIF is a safe and reliable procedure for treatment of lumbar spondylolisthesis grade 1 and 2 with potential advantages.
回顾性分析采用微创和开放经椎间孔腰椎椎体间融合术（TLIF）治疗腰椎滑脱症的情况，并比较两种技术的临床效果。
2006年6月至2010年5月，371例1级和2级腰椎滑脱症患者接受了TLIF、椎弓根螺钉固定并进行随访。平均年龄为50.4岁（范围37 - 85岁）。172例行微创TLIF及经皮椎弓根螺钉固定的患者设为微创TLIF组，199例行开放TLIF及椎弓根螺钉固定的患者设为开放TLIF组。比较两组的手术时间、失血量、X线暴露时间及并发症情况。采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评估临床疗效。末次随访时通过CT扫描重建及腰椎动态X线片确定融合率。
平均随访时间为32.7个月，范围12 - 58个月。两组在性别、年龄、腰椎滑脱分级及融合节段方面表现相同。微创TLIF组术中平均失血量（310±75）ml及术后失血量（38±13）ml显著优于开放TLIF组术中失血量（623±156）ml及术后失血量（184±72）ml（t = 2.836和3.274，P < 0.01）。与开放TLIF组（20±10）s相比，微创TLIF组的放射时间明显更长（51±19）s（t = 2.738，P < 0.01）。两组在手术时间、下腰痛VAS评分、ODI评分及并发症发生率方面无统计学差异。
与开放TLIF相比，微创TLIF是治疗1级和2级腰椎滑脱症安全可靠的手术方法，具有潜在优势。
