经椎间孔腰椎体间融合术中关节突关节整块切除的临床效果——双层双隧道策略

Clinical Effects of Upper Facet Joint En Bloc Resection in the Transforaminal Lumbar Interbody Fusion Surgery-Two Layers and Two Tunnels Strategy.

机构信息

Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.

Tianjin Medical University General Hospital, Tianjin First Central Hospital, Tianjin, China.

出版信息

Orthop Surg. 2023 May;15(5):1272-1280. doi: 10.1111/os.13695. Epub 2023 Mar 27.

DOI:10.1111/os.13695

PMID:36973935

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10157721/

Abstract

OBJECTIVE

The upper facet joint en bloc resection is the key step to open the intervertebral foramina for achieving the intervertebral fusion in transforaminal lumbar interbody fusion (TLIF) surgery. Our purpose is to introduce a upper facet joint resection technique which can avoid injuring the nerve root termed "two layers and two tunnels strategy" in TLIF surgery and to evaluate its clinical effects and neurological safety.

METHODS

All 108 patients who underwent TLIF surgery using two layers and two tunnels strategy between December 2015 and January 2019 were analyzed for postoperative clinical treatment parameter. The visual analogue scale (VAS) method, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) scores and the Macnab scoring system were used to evaluate the clinical effects during post-operative check-ups at 7 days, 3 months, 6 months, and the last follow-up visit. Data were represented by mean and standard deviation, and repeated measures analysis of variance was performed to make comparison.

RESULTS

The result noted that, the VAS scores for back pain decreased by 30.13% at 7 days post-operation (3.64 ± 0.86), 63.15% at 3 months (1.92 ± 0.55), 72.17% at 6 months (1.45 ± 0.61) and 70.44% at the last follow-up (1.54 ± 0.62) compared with pre-operation (5.21 ± 0.93). The VAS scores for lower limb pain decreased by 44.22% at 7 days (3.86 ± 0.90), 61.42% at 3 months (2.67 ± 0.72), 66.62% at 6 months (2.31 ± 0.79) and 66.47% at the last follow-up (2.32 ± 0.72) compared with pre-operation (6.92 ± 1.04). The ODI scores decreased by 49.08% at 7 days (32.19 ± 5.13), 67.92% at 3 months (20.28 ± 5.50), 74.00% at 6 months (16.44 ± 4.21) and 75.42% at the last follow-up (15.54 ± 3.85) compared with pre-operation (63.22 ± 7.58). The JOA scores increased by 51.41% at 7 days (18.49 ± 1.48), 69.26% at 3 months (22.35 ± 1.44), 73.28% at 6 months (23.22 ± 1.18) and 77.53% at the last follow-up (24.14 ± 0.99) compared with pre-operation (7.37 ± 1.71). Among 108 cases, there is no neurological complications.

CONCLUSION

Two layers and two tunnels strategy is an effective and safe procedure that can certainly avoid nerve root injury to reduce neurological complication and increase safety of TLIF surgery.

摘要

目的

上关节突整块切除是经椎间孔腰椎体间融合术（TLIF）中打开椎间孔以实现椎间融合的关键步骤。我们的目的是介绍一种上关节突切除技术，该技术可以避免神经根损伤，我们称之为 TLIF 手术中的“两层两隧道策略”，并评估其临床效果和神经安全性。

方法

回顾性分析 2015 年 12 月至 2019 年 1 月采用“两层两隧道策略”行 TLIF 手术的 108 例患者的术后临床治疗参数。采用视觉模拟评分法（VAS）、Oswestry 功能障碍指数（ODI）、日本骨科协会（JOA）评分和 Macnab 评分系统在术后 7d、3 个月、6 个月和末次随访时对临床疗效进行评估。数据用均数和标准差表示，采用重复测量方差分析进行比较。

结果

术后 7d 时，腰痛 VAS 评分降低了 30.13%（3.64±0.86），3 个月时降低了 63.15%（1.92±0.55），6 个月时降低了 72.17%（1.45±0.61），末次随访时降低了 70.44%（1.54±0.62），与术前（5.21±0.93）相比。术后 7d 时，下肢疼痛 VAS 评分降低了 44.22%（3.86±0.90），3 个月时降低了 61.42%（2.67±0.72），6 个月时降低了 66.62%（2.31±0.79），末次随访时降低了 66.47%（2.32±0.72），与术前（6.92±1.04）相比。ODI 评分术后 7d 降低了 49.08%（32.19±5.13），3 个月时降低了 67.92%（20.28±5.50），6 个月时降低了 74.00%（16.44±4.21），末次随访时降低了 75.42%（15.54±3.85），与术前（63.22±7.58）相比。JOA 评分术后 7d 时提高了 51.41%（18.49±1.48），3 个月时提高了 69.26%（22.35±1.44），6 个月时提高了 73.28%（23.22±1.18），末次随访时提高了 77.53%（24.14±0.99），与术前（7.37±1.71）相比。108 例患者中无神经并发症。