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斜外侧入路与微创经椎间孔入路椎间融合术治疗退变性腰椎滑脱的早期疗效及影像学对比
Hits: 3542   Download times: 436   Received:January 13, 2020    
作者Author单位UnitE-Mail
陈晓 CHEN Xiao 潍坊医学院临床医学院, 山东 潍坊 261042
潍坊医学院附属医院脊柱外科, 山东 潍坊 261042
Clinical Medical College of Weifang Medical University, Weifang 261042, Shangdong, China
Department of Spine Surgery, Affiliated Hospital of Weifang Medical University, Weifang 261042, Shangdong, China
 
吴磊磊 WU Lei-lei 潍坊医学院附属医院脊柱外科, 山东 潍坊 261042 Department of Spine Surgery, Affiliated Hospital of Weifang Medical University, Weifang 261042, Shangdong, China  
杨泽城 YANG Ze-cheng 潍坊医学院临床医学院, 山东 潍坊 261042 Clinical Medical College of Weifang Medical University, Weifang 261042, Shangdong, China  
邱玉金 QIU Yu-jin 潍坊医学院附属医院脊柱外科, 山东 潍坊 261042 Department of Spine Surgery, Affiliated Hospital of Weifang Medical University, Weifang 261042, Shangdong, China qiuwygk@163.com 
期刊信息:《中国骨伤》2023年36卷,第5期,第414-419页
DOI:10.12200/j.issn.1003-0034.2023.05.004


目的:比较斜外侧入路腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)和Quadrant可扩张通道下微创经椎间孔入路腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗退变性腰椎滑脱的短期临床疗效及影像学差异。

方法:对2019年4月至2020年10月行OLIF与MIS-TLIF两种微创手术方式治疗的58例腰椎滑脱患者进行回顾性分析。其中采用OLIF治疗28例(OLIF组),男15例,女13例;年龄47~84(63.00±9.38)岁;采用MIS-TLIF治疗30例(MIS-TLIF组),男17例,女13例;年龄43~78岁(61.13±11.10)岁。记录两组患者的一般情况,包括手术时间、术中出血量、术后引流量、并发症、卧床时间、住院时间;比较两组患者的影像学资料,包括椎间盘高度、椎间孔高度、腰椎前凸角;并通过疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)对临床疗效进行评定。

结果: OLIF组在手术时间、术中出血量、术后引流量、卧床时间及住院时间方面明显少于MIS-TLIF组(P<0.05)。两组术后椎间盘高度、椎间孔高度较术前均有明显改善(P<0.05),OLIF组腰椎前凸角较术前有显著改善(P<0.05),MIS-TLIF组腰椎前凸角手术前后差异无统计学意义(P>0.05);OLIF组术后椎间盘高度、椎间孔高度、腰椎前凸角的纠正优于MIS-TLIF组(P<0.05)。OLIF组术后1周、1个月VAS和术后1个月ODI低于MIS-TLIF组(P<0.05),术后3、6个月,两组患者的VAS和ODI差异无统计学意义(P>0.05)。并发症:OLIF组术后发生左下肢感觉异常及屈髋无力1例,终板塌陷1例。MIS-TLIF组发生术后减压侧下肢放射痛2例。

结论:与MIS-TLIF相比,OLIF对患者造成的手术创伤更小,腰椎术后康复及功能恢复更快,影像学方面有更好的表现。
[关键词]:腰椎  脊椎滑脱  脊柱融合术  外科手术,微创性
 
Clinical and radiologic comparison between oblique lateral interbody fusion and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis
Abstract:

Objective To compare the short-term clinical efficacy and radiologic differences between oblique lateral interbody fusion(OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis.

Methods A retrospective analysis was performed on 58 patients with lumbar spondylolisthesis treated with OLIF or MIS-TLIF from April 2019 to October 2020. Among them,28 patients were treated with OLIF (OLIF group),including 15 males and 13 females aged 47 to 84 years old with an average age of (63.00±9.38) years. The other 30 patients were treated with MIS-TLIF(MIS-TLIF group),including 17 males and 13 females aged 43 to 78 years old with an average age of (61.13±11.10) years. General conditions,including operation time,intraoperative blood loss,postoperative drainage,complications,lying in bed,and hospitalization time were recorded in both groups. Radiological characteristics,including intervertebral disc height (DH),intervertebral foramen height (FH),and lumbar lordosis angle (LLA),were compared between two groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical effect.

Results The operation time,intraoperative blood loss,postoperative drainage,lying in bed,and hospitalization time in OLIF group were significantly less than those in the MIS-TLIF group (P<0.05). The intervertebral disc height and intervertebral foramen height were significantly improved in both groups after the operation (P<0.05). The lumbar lordosis angle in OLIF group was significantly improved compared to before the operation (P<0.05),but there was no significant difference in the MIS-TLIF group before and after operation(P>0.05). Postoperative intervertebral disc height,intervertebral foramen height,and lumbar lordosis were better in the OLIF group than in the MIS-TLIF group (P<0.05). The VAS and ODI of the OLIF group were lower than those of the MIS-TLIF group within 1 week and 1 month after the operation (P<0.05),and there were no significant differences in VAS and ODI at 3 and 6 months after the operation between the two groups(P>0.05). In the OLIF group,1 case had paresthesia of the left lower extremity with flexion-hip weakness and 1 case had a collapse of the endplate after the operation;in the MIS-TLIF group,2 cases had radiation pain of lower extremities after decompression.

Conclusion Compared with MIS-TLIF,OLIF results in less operative trauma,faster recovery,and better imaging performance after lumbar spine surgery.
KEYWORDS:Lumabr vertebrae  Spondylolysis  Spinal fusion  Surgical procedures,minimally invasive
 
引用本文,请按以下格式著录参考文献:
中文格式:陈晓,吴磊磊,杨泽城,邱玉金.斜外侧入路与微创经椎间孔入路椎间融合术治疗退变性腰椎滑脱的早期疗效及影像学对比[J].中国骨伤,2023,36(5):414~419
英文格式:CHEN Xiao,WU Lei-lei,YANG Ze-cheng,QIU Yu-jin.Clinical and radiologic comparison between oblique lateral interbody fusion and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(5):414~419
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