中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (9): 1387-1392.doi: 10.3969/j.issn.2095-4344.4013

• 脊柱植入物Spinal implants • 上一篇    下一篇

微创经椎间孔椎间融合治疗单节段腰椎管狭窄症对腰椎-骨盆平衡的改善作用

姚汝斌，王仕永，杨开舜   

  1. 大理大学第一附属医院脊柱外科，云南省大理市   671000
  • 收稿日期:2020-04-11 修回日期:2020-04-18 接受日期:2020-05-20 出版日期:2021-03-28 发布日期:2020-12-15
  • 通讯作者: 杨开舜，硕士，主任医师，硕士生导师，大理大学第一附属医院脊柱外科，云南省大理市 671000
  • 作者简介:姚汝斌，男，1972年生，云南省永平县人，彝族，2004年大理医学院毕业，副主任医师，主要从事脊柱退变性疾病及脊柱畸形方面的研究。 王仕永，男，1991年生，云南省会泽县人，汉族，2018年大理大学毕业，硕士，医师，主要从事脊柱退变性疾病及脊柱畸形方面的研究。

Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance

Yao Rubin, Wang Shiyong, Yang Kaishun   

  1. Department of Spinal Surgery, the First Affiliated Hospital of Dali University, Dali 671000, Yunnan Province, China
  • Received:2020-04-11 Revised:2020-04-18 Accepted:2020-05-20 Online:2021-03-28 Published:2020-12-15
  • Contact: Yang Kaishun, Master, Chief physician, Master’s supervisor, Department of Spinal Surgery, the First Affiliated Hospital of Dali University, Dali 671000, Yunnan Province, China
  • About author:Yao Rubin, Associate chief physician, Department of Spinal Surgery, the First Affiliated Hospital of Dali University, Dali 671000, Yunnan Province, China Wang Shiyong, Master, Physician, Department of Spinal Surgery, the First Affiliated Hospital of Dali University, Dali 671000, Yunnan Province, China

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摘要：

文题释义：
微创经椎间孔椎间融合：于2002年Foley等首次报道，该技术不破坏多裂肌在棘突的起点部位，通过解剖明确的神经血管和肌肉间隙，限制外科操作通道的宽度来减少软组织损伤。
腰椎-骨盆参数：骨盆形态对整个脊柱序列有决定性作用，也是脊柱尤其是腰椎生理曲度重建的重要参考指标，目前被广泛使用的腰椎-骨盆矢状位参数有骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸角、腰椎节段前凸、L1中垂线与S1后上角的距离等。

背景：越来越多的研究认为腰椎-骨盆参数与腰椎融合术后的临床效果以及邻近节段退变密切相关，但微创经椎间孔椎间融合对腰椎-骨盆参数的影响并不明确。
目的：评价微创经椎间孔椎间融合对单节段腰椎管狭窄症患者腰椎-骨盆影像学参数的影响。
方法：回顾性分析2015年1月至2017年1月于大理大学第一附属医院就诊，采用经椎间孔椎间融合治疗的85例单节段腰椎管狭窄症患者的临床资料，其中行微创经椎间孔椎间融合手术39例(微创组)，行开放经椎间孔椎间融合手术46例(开放组)。在包含双侧股骨头的站立腰椎侧位X射线片上，测量所有患者术前及末次随访时的腰椎前凸角、节段前凸角、椎间高度、L1中垂线与S1后上角的距离、骨盆入射角、骨盆倾斜角、骶骨倾斜角，并计算骨盆入射角与腰椎前凸角的差值及腰椎前凸角与骨盆入射角的比值。
结果与结论：①末次随访时，两组的腰椎前凸角、椎间高度、骶骨倾斜角均较术前增大，而骨盆倾斜角较术前减小，差异均有显著性意义(P < 0.05)；两组末次随访时的腰椎前凸角、节段前凸角、椎间高度、骨盆入射角、骨盆倾斜角、骶骨倾斜角、L1中垂线与S1后上角的距离相比，差异均无显著性意义(P > 0.05)；②末次随访时，两组的腰椎前凸角、节段前凸角、椎间高度、骨盆入射角、骨盆倾斜角、骶骨倾斜角、L1中垂线与S1后上角的距离与术前对应参数的差值相比，差异均无显著性意义(P > 0.05)；③两组的骨盆入射角与腰椎前凸角差值在末次随访时均较术前明显减小，差异有显著性意义(P < 0.05)；两组的腰椎前凸角与骨盆入射角比值在末次随访时均较术前增大，其中开放组变化显著(P < 0.05)；但骨盆入射角与腰椎前凸角差值及腰椎前凸角与骨盆入射角比值两组间比较，差异均无显著性意义(P > 0.05)；④提示对于单节段腰椎椎管狭窄症，与开放经椎间孔椎间融合相比，微创经椎间孔椎间融合在恢复腰椎生理前凸、椎间高度、改善腰椎-骨盆平衡方面拥有同等的效果。
https://orcid.org/0000-0001-6481-6816 (姚汝斌) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 腰椎, 腰椎管狭窄, 骨盆, 微创, 经椎间孔椎间融合, 单节段

Abstract: BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear.   
OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis.
METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. 
RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P < 0.05). Lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope and the L1 axis and S1 distance were not significantly different between the two groups during the last follow-up (P > 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups    (P < 0.05). The ratio of lumbar lordosis/pelvic incidence was significantly increased at the last follow-up compared with preoperative parameters in the two groups, especially in the open-TLIF group (P < 0.05). However, the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were not significantly different between the two groups (P > 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.

Key words: lumbar spine, lumbar spinal stenosis, pelvis, minimally invasive, transforaminal lumbar interbody fusion, single segment

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