经椎间孔椎体间融合横向与斜向笼架置入比较

Transverse versus oblique placements of fusion cage in transforaminal lumbar interbody fusion

摘要:

［目的］ 比较经椎间孔椎体间融合术 （transforaminal lumbar interbody fusion, TLIF） 横向与斜向笼架置的临床效果。 ［方法］ 2018 年 3 月—2020 年 8 月，对 57 例腰椎退行性疾病行 TLIF 术。依据术前医患沟通结果，23 例采用横向放置椎间笼架，34 例采用斜向放置笼架。比较两组患者围手术期、随访及影像结果。［结果］两组患者均顺利完成手术，术中无神经、血管、硬膜囊损伤等严重并发症。两组手术时间、切口长度、术中出血量、术中透视次数、下地时间及住院时间的差异均无统计学意义（P>0.05）。两组患者均获随访（30.44±10.55）个月，两组恢复完全负重时间的差异无统计学意义（P> 0.05），两组末次随访时 VAS、ODI、OA 评分较术前均显著改善（P<0.05），相应时间点，两组间 VAS、ODI 及 JOA 评分的差异均无统计学意义 （P>0.05）。影像方面，相应时间点，两组间椎间隙高度、Lenke 融合评级和融合量评级的差异均无统计学意义（P>0.05）。末次随访时横向组融合器后侧融合率显著高于斜向组 （P<0.05），而其他分区两组间差异均无统计学意义 （P>0.05）。［结论］ 腰椎融合手术采取横向和斜向置入椎间笼架均能取得满意的疗效，但横向放置椎间笼架其后侧融合率更高。

Abstract:

[Objective] To compare the clinical outcomes of transverse versus oblique placements of fusion cage in transforaminal lum- bar interbody fusion (TLIF) . [Methods] From March 2018 to August 2020, a total of 57 patients received TLIF for lumbar degenerative dis- eases in our department. According to preoperative doctor- patient communication, 23 patients had the fusion cage placed transversely, while the remaining 34 patients had the cage inserted obliquely. The perioperative, follow-up and imaging results were compared between the two groups. [Results] All the patients in both groups had operation performed successfully without serious complications such as injures to the nerve, blood vessel and dural sac. There were no significant differences in operative time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, postoperative walking time and hospital stay between the two groups (P＜0.05) . All the patients in both groups were followed up for (30.44±10.55) months on an average, with no significant difference in the time to resume full weight-bearing ac- tivity between the two groups (P＞0.05) . The VAS and ODI scores significantly decreased (P＜0.05) , whereas the JOA score significantly in- creased in both groups at the latest follow-up compared with those before surgery (P＜0.05) . However, there were no significant differences in VAS, ODI and JOA scores between the two groups at any corresponding time points (P＞0.05) . Radiographically, there were no statisti- cally significant differences in intervertebral space height, Lenke fusion grade and fusion volume scale between the two groups at any corre- sponding time points (P＞0.05) . The transverse group proved significantly superior to the oblique group in term of fusion rate at the area pos- terior to the cage at the latest follow up (P＜0.05) , despite of the fact that no significant differences were noticed in fusion rate at the latest follow up in the remaining intervertebral areas between the two groups (P＞0.05) . [Conclusion] Both transverse and oblique cage place- ments in TLIF do achieve satisfactory clinical outcomes for degenerative diseases, by contrast, the transverse cage placement got better fu- sion in the area posterior the cage.