曹峰　李纯志　程继伟

[摘要] 目的 研究微创经椎间孔椎间融合术（MIS-TLIF）联合椎弓根螺钉内固定术（PSF）治疗退行性腰椎侧弯患者的临床疗效。 方法 选择我院收治的退行性腰椎侧弯患者45例作为研究对象，均采用MIS-TLIF联合PSF治疗，比较患者手术前、手术后1周、手术后3个月、末次随访时VAS评分、SF-36评分、ODI评分、腰椎前凸角、Cobb角、冠状位躯干偏移、矢状位躯干偏移，评价患者椎体融合率和术后的减压程度。 结果 平均手术时间（208.54±24.55）min，平均术中出血量（327.85±42.08）mL，平均住院时间（8.54±1.04）d。术后患者的VAS评分和ODI评分明显降低（P<0.05），术后患者的SF-36评分明显升高（P<0.05）。手术后患者的腰椎前凸角、Cobb角、冠状位躯干偏移、矢状位躯干偏移均明显降低，与手术前比较差异有统计学意义（P<0.05）。术后患者的平均ODI改善率为（87.04±5.43）%，椎体的融合率90.04%，减压程度（94.05±3.87）%。 结论 MIS-TLIF联合PSF治疗退行性腰椎侧弯患者具有创伤小、出血量少、并发症少等特点，矫形效果佳，是治疗退行性腰椎侧弯患者的不错选择。

[关键词] 微创手术；椎间孔椎间融合术；退行性疾病；腰椎侧弯

[中圖分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2017）24-0089-05

[Abstract] Objective To study the clinical effect of minimally invasive transforaminal lumbar interbody fusion（MIS-TLIF） combined with pedicle screw fixation（PSF） in the treatment of degenerative lumbar scoliosis. Methods A total of 45 patients with degenerative lumbar scoliosis admitted in our hospital were enrolled in this study. All the patients were treated with MIS-TLIF combined with PSF. The VAS score， SF-36 score， ODI score， lumbar lordosis angle， Cobb angle， coronal torso offset， sagittal torso sffset were compared between the patients before surgery， at 1 week and 3 months after surgery， and at the last follow-up. The vertebral fusion rate and postoperative decompression degree were evaluated. Results The average operation time was（208.54±24.55） min， the average amount of bleeding during operation was（327.85±42.08） mL and the average hospitalization time was（8.54±1.04）days in each patient. The VAS score and ODI score of the patients were significantly decreased（P<0.05）， and the SF-36 score was significantly increased in the postoperative patients（P<0.05）. The lumbar lordosis angle， Cobb angle， coronal torso offset and sagittal torso sffset were significantly decreased in the patients after operation， which were significantly different from those before operation （P<0.05）. The average improvement rate of ODI was （87.04±5.43）%， the fusion rate of vertebral body was 90.04% and the degree of decompression （94.05±3.87）% in the postoperative patients. Conclusion MIS-TLIF combined with PSF for the treatment of degenerative lumbar scoliosis patients has less trauma， less bleeding， fewer complications and other characteristics， with good orthopedic effect， which is a good choice for the treatment of degenerative lumbar scoliosis patients.

[Key words] Minimally invasive surgery； Transforaminal lumbar interbody fusion； Degenerative disease； Lumbar scoliosisendprint

随着我国社会老年化的加速，退行性脊柱侧弯逐渐成为一种严重的退行性疾病，其发生率明显增加，导致患者酸痛、间歇性破行、下肢痛等，严重影响患者的生活质量[1-3]。目前治疗退行性脊柱侧弯的最佳方法是手术治疗，由于退行性脊柱侧弯多发生于老年患者，而老年患者的体质较差，容易出现骨质疏松等慢性疾病，因此对于老年退行性脊柱侧弯患者的手术方式的选择以及如何确定和定位融合椎体节段成为研究的热点[4，5]。近年来微创手术在脊柱外科研究中发展迅速，同时脊柱内固定的材料和技术也在不断优化，脊柱内固定术给患者带来的创伤逐渐减小，最具有代表性的技术有MIS-TLIF、经皮椎弓根螺钉内固定术等[6-8]。本研究以45例退行性腰椎侧弯患者作为研究对象，探讨MIS-TLIF联合经皮椎弓根螺钉内固定术治疗退行性腰椎侧弯的疗效和对脊柱功能的影响，现报道如下。……