摘要：

目的 探讨微创经椎间孔腰椎间融合术（MIS-TLIF）联合经皮螺钉内固定融合术治疗退行性腰椎滑脱的临床疗效。方法 采用MIS-TLIF 联合经皮螺钉内固定融合术共治疗32 例退行性腰椎滑脱患者，比较术前和术后1 周、3 个月、末次随访时视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）和36 条简明健康状况调查表（SF-36）评分，以及X 线测量腰椎前凸角、冠状位Cobb 角、冠状位和矢状位躯干偏移、腰椎滑脱程度（Meyerding 分度）并计算滑脱率，X 线或CT 判断椎体融合率，MRI 评价减压程度。结果 32 例患者平均手术时间160 min，术中出血量120 ml，住院时间7.22 d，术后随访10.83 个月。手术融合41 个椎体节段，范围覆盖L2 ~ S1 节段。与术前相比，术后1 周、3 个月和末次随访时VAS（均P = 0.000）和ODI（均P = 0.000）评分增加，SF-36 评分减少（P = 0.002，0.000，0.000），腰椎前凸角（均P = 0.000）、冠状位Cobb 角（均P = 0.000）和滑脱率（均P = 0.000）均减小。至末次随访时，ODI 改善率为（80.51 ± 6.02）%，椎体融合率达92.22%且螺钉位置均良好。32 例患者中1 例术后感染、2 例脑脊液漏，经对症治疗均痊愈；无一例发生神经功能缺损等严重并发症、内固定失败、椎弓根螺钉和钛棒断裂或Cage移位，无一例死亡。结论 MIS-TLIF 联合经皮螺钉内固定融合术创伤小、术中出血量少、并发症轻微、复位效果好、疗效确切，尽管存在手术时间较长、学习曲线较长、术中X 线照射量较大等缺点，但仍是治疗退行性腰椎滑脱的有效方法。

关键词: 脊椎滑脱, 腰椎, 脊柱融合术, 内固定术（非MeSH 词）, 外科手术, 微创性

Abstract:

Objective  To discuss clinical therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) combined with percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis (DLS).  Methods  A total of 32 DLS patients treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University were retrospectively reviewed. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scores were assessed and compared between preoperation and one week, 3 months after operation and in the last follow-up. Lumbar lordosis angle, coronal Cobb angle, coronal and sagittal body shifting, complication, the degree of spondylolisthesis (Meyerding classification) and the rate of spondylolisthesis were measured according to preoperative and postoperative spinal X-ray examination. Fusion rate was evaluated according to X-rays or CT in the last follow-up, and MRI was used to assess the degree of decompression.  Results  Thirty-two patients were under test with mean operation time 160 min, intraoperative blood loss 120 ml, postoperative hospital stay 7.22 d and follow-up 10.83 months. Decompression and fusion levels ranged from L2-S1 and interbody fusion was performed in 32 patients and 41 levels were fused. Compared with preoperation, the VAS and ODI scores were significantly increased at one week, 3 months after operation and in the last follow-up (P = 0.000, for all), while SF-36 score (P = 0.002, 0.000, 0.000), lumbar lordotic angle (P = 0.000, for all), coronal Cobb angle (P = 0.000, for all) and slippage rate (P = 0.000, for all) were significantly decreased. The fusion rate was 92.22%, and the improvement rate of ODI was (80.51 ± 6.02)% in the last follow-up. There were 3 cases appeared complications, including one case of infection and 2 cases of cerebrospinal fluid (CSF) fistula, and were cured after treatment. Neurological defects, internal fixation failure, breakage of pedicle screw or titanium rod, or Cage displacement were not found in 32 cases. There was no death.  Conclusions  MIS-TLIF combined with percutaneous pedicle screw fixation is an effective technique for treatment of DLS patients, with less injury, less intraoperative blood loss, low complication incidence rate, good scoliosis correction and definite therapeutic effects, even this method needs more operation time, longer learning curve and more radiation.

Key words: Spondylolysis, Lumbar vertebrae, Spinal fusion, Internal fixation (not in MeSH), Surgical procedures, minimally invasive