Objective: To compare the effectiveness of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and Wiltse-approach TLIF (W-TLIF) in the treatment of lumbar spondylolisthesis.
Methods: The clinical data of 47 patients with lumbar spondylolisthesis who met the selection criteria between July 2018 and June 2019 were retrospectively analyzed, in which 21 patients were treated with PE-TLIF (PE-TLIF group) and 26 patients were treated with W-TLIF (W-TLIF group). There was no significant difference between the two groups in age, gender, disease duration, level of spondylolisthesis vertebrae, spondylolisthesis degree, spondylolisthesis type, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, lumbar Japanese Orthopaedic Association (JOA) score, and the disc height (DH), segmental lordosis (SL), and Taillard index (TI) of the operated vertebrae ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, postoperative bedridden time, and complications were compared between the two groups. The VAS score and JOA score were used to evaluate the improvement of pain and function. At last follow-up, DH, SL, and TI of operated vertebrae were measured by X-ray films, and lumbar CT was performed to evaluate the interbody fusion.
Results: Compared with W-TLIF group, the operation time in PE-TLIF group was significantly longer, but the intraoperative blood loss and postoperative drainage were significantly less, and the postoperative bedridden time was significantly shorter ( P<0.05). There were 2 cases of transient lower limb radiating pain in PE-TLIF group and 1 case of superficial incision infection in W-TLIF group. There was no significant difference in the incidence of complications (9.5% vs. 3.8%) between the two groups ( χ 2=0.037, P=0.848). The patients in both groups were followed up 12-24 months, with an average of 17.3 months in PE-TLIF group and 17.7 months in W-TLIF group. The VAS scores of low back pain and leg pain, and the JOA scores of the two groups significantly improved at each time point after operation when compared with those before operation ( P<0.05). Compared with W-TLIF group, the VAS scores of low back pain in PE-TLIF group significantly lower at 3 days and 3 months after operation ( P<0.05), and the JOA score of PE-TLIF group was significantly higher at 3 months after operation ( P<0.05), and there was no significant difference in each score at any other time point between the two groups ( P>0.05). At last follow-up, the DH, SL, and TI of operated vertebrae of the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference in the differences of each parameter between the two groups ( P>0.05). According to Suk's standard, the fusion rates of PE-TLIF group and W-TLIF group were 90.5% (19/21) and 92.3% (24/26), respectively, with no significant difference ( χ 2=0.000, P=1.000). At last follow-up, there was no case of Cage sunk into the adjacent vertebral body, or dislodgement of Cage anteriorly or posteriorly in both groups.
Conclusion: PE-TLIF and W-TLIF are both effective in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis. Although the operation time is prolonged, PE-TLIF has less intraoperative blood loss and postoperative drainage, shorter postoperative bedridden time, and can get more obvious short-term improvement of low back pain and function.
目的: 比较经皮内镜下经椎间孔腰椎间融合术（percutaneous endoscopic transforaminal lumbar interbody fusion，PE-TLIF）与Wiltse入路TLIF（Wiltse-approach TLIF，W-TLIF）治疗腰椎滑脱症的疗效。.
方法: 回顾分析2018年7月—2019年6月符合选择标准的47例行手术治疗的腰椎滑脱症患者临床资料，其中21例采用PE-TLIF治疗（PE-TLIF组），26例采用W-TLIF治疗（W-TLIF组）。两组患者年龄、性别、病程、滑脱椎体、滑脱分度、滑脱分型及术前腰腿疼痛视觉模拟评分（VAS）、腰椎日本骨科学会（JOA）评分、手术节段椎间隙高度（disc height，DH）、节段性前凸角（segmental lordosis，SL）及Taillard指数（Taillard index，TI）比较，差异均无统计学意义（ P>0.05）。比较两组手术时间、术中出血量、术后引流量、术后卧床时间及并发症发生情况；采用VAS评分及JOA评分评价疼痛及功能改善情况；末次随访时于X线片上测量手术节段DH、SL及TI，并行腰椎CT检查，按Suk标准评测椎间融合情况。.
结果: 与W-TLIF组相比，PE-TLIF组手术时间明显延长，但术中出血量及术后引流量减少、术后卧床时间明显缩短（ P<0.05）。术后PE-TLIF组出现2例一过性下肢放射痛，W-TLIF组出现1例浅表切口感染，两组并发症发生率（9.5% vs. 3.8%）差异无统计学意义（ χ 2=0.037， P=0.848）。两组患者均获随访，PE-TLIF 组随访时间12～24个月，平均17.3个月；W-TLIF 组为12～24个月，平均17.7个月。两组术后各时间点腰腿痛VAS评分及JOA评分均较术前显著改善（ P<0.05）。PE-TLIF组术后3 d及3个月腰痛VAS评分显著低于W-TLIF组，术后3个月腰椎JOA评分显著高于W-TLIF组，差异均有统计学意义（ P<0.05）；其余时间点两组间各评分比较差异均无统计学意义（ P>0.05）。末次随访时，两组手术节段DH、SL及TI均较术前显著改善（ P<0.05），两组间各指标手术前后差值比较差异均无统计学意义（ P>0.05）。按Suk标准评价，PE-TLIF组和W-TLIF组融合率为90.5%（19/21）和92.3%（24/26），差异无统计学意义（ χ 2=0.000， P=1.000）。末次随访时两组均未见融合器沉降进入邻近椎体或向前、后移位。.
结论: PE-TLIF和W-TLIF治疗Ⅰ、Ⅱ度腰椎滑脱症均可获得良好疗效，尽管PE-TLIF手术时间延长，但术中出血量及术后引流量少，术后卧床时间短，且早期腰痛及功能改善更明显。.
Keywords: Lumbar spondylolisthesis; decompression; percutaneous endoscopic surgery; transforaminal lumbar interbody fusion.