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基于椎间矫正概念的经椎间孔腰椎椎间融合术治疗退变性腰椎侧弯

Treatment of degenerative lumbar scoliosis using transforaminal lumbar interbody fusion based on the concept of intervertebral correction.

作者信息

Lai Juyi, Tan Huangsheng, Feng Hualong, Lan Zhiming, Sun Zhitao, Wang Jian, Fu Yuanfei, He Shenghua

机构信息

The Fourth Clinical Medical College Affiliated to Guangzhou University of Chinese Medicine, Guangzhou, China.

Shenzhen Traditional Chinese Medicine Hospital, No.1, Fuhua Road, Futian District, Shenzhen, Guangdong Province, China.

出版信息

Int Orthop. 2023 May;47(5):1303-1313. doi: 10.1007/s00264-023-05774-1. Epub 2023 Mar 18.

Abstract

PURPOSE

The study aimed to examine the outcomes of posterior approach transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS) based on the concept of intervertebral correction.

METHODS

A retrospective analysis was performed on 76 surgical patients (36 males and 40 females) who underwent posterior TLIF and internal fixation based on the concept of intervertebral correction in Shenzhen Traditional Chinese Medicine Hospital from February 2014 to March 2021.The operation duration, intraoperative blood loss, incision length, and complications were recorded. Clinical efficacy was evaluated preoperatively and postoperative time points through the visual analog scale (VAS) and the Oswestry disability index (ODI). The changes in the coronal scoliosis curve (Cobb angle), coronal balance distance (CBD), the sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt angle (PT) were assessed perioperatively at the last follow-up.

RESULTS

All patients successfully underwent the operation. The average operation duration was 243.81 ± 35.35 (220 - 350) min; the average intraoperative blood loss was 836.27 ± 50.28 (700 - 2500) mL; the average incision length was 8.30 ± 2.33 (8 - 15) cm. The total complication rate was 18.42% (14/76). The VAS score of low back pain, lower extremity pain, and ODI score of patients at the last follow-up was significantly improved compared with those before the operation (P < 0.05). At the last follow-up, the Cobb Angle, CBD, SVA, and PT of patients were significantly lower than those before the operation (P < 0.05), and LL was higher than those before the operation (P < 0.05).

CONCLUSION

TLIF based on the concept of intervertebral correction for the treatment of DLS may provide favourable clinical outcomes.

摘要

目的

本研究旨在基于椎间矫正概念探讨后路经椎间孔腰椎椎间融合术(TLIF)治疗退变性腰椎侧弯(DLS)的疗效。

方法

对2014年2月至2021年3月在深圳市中医院接受基于椎间矫正概念的后路TLIF及内固定手术的76例手术患者(男36例,女40例)进行回顾性分析。记录手术时间、术中出血量、切口长度及并发症情况。通过视觉模拟量表(VAS)和Oswestry功能障碍指数(ODI)在术前及术后各时间点评估临床疗效。在末次随访时围手术期评估冠状面侧弯角度(Cobb角)、冠状面平衡距离(CBD)、矢状面垂直轴(SVA)、腰椎前凸(LL)及骨盆倾斜角(PT)的变化。

结果

所有患者手术均成功。平均手术时间为243.81±35.(220 - 350)分钟;平均术中出血量为836.27±50.28(700 - 2500)毫升;平均切口长度为8.30±2.33(8 - 15)厘米。总并发症发生率为18.42%(14/76)。末次随访时患者的腰痛VAS评分、下肢疼痛VAS评分及ODI评分较术前均显著改善(P < 0.05)。末次随访时,患者的Cobb角、CBD、SVA及PT均显著低于术前(P < 0.05),而LL高于术前(P < 0.05)。

结论

基于椎间矫正概念的TLIF治疗DLS可能提供良好的临床疗效。

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