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斜外侧椎间融合术与经椎间孔椎间融合术在治疗单节段退行性椎管狭窄的疗效及肌肉损伤影像学比较
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作者Author单位UnitE-Mail
李三标 LI San-biao 建德市中西医结合医院骨科, 浙江 建德 311600 Department of Orthopaedics, Jiande Hospital of Integrated Traditional Chinese and Western Medicine, Jiande 311600, Zhejiang, China  
梅盛前 MEI Sheng-qian 建德市中西医结合医院骨科, 浙江 建德 311600 Department of Orthopaedics, Jiande Hospital of Integrated Traditional Chinese and Western Medicine, Jiande 311600, Zhejiang, China  
徐文斌 XU Wen-bin 浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 Department of Orthopaedics, Sir Run Run Show Hospital Affiliated to Zhejiang University Medical School, Hangzhou 310016, Zhejiang, China  
方向前 FANG Xiang-qian 浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 Department of Orthopaedics, Sir Run Run Show Hospital Affiliated to Zhejiang University Medical School, Hangzhou 310016, Zhejiang, China  
范顺武 FAN Shun-wu 浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 Department of Orthopaedics, Sir Run Run Show Hospital Affiliated to Zhejiang University Medical School, Hangzhou 310016, Zhejiang, China  
黄力斌 HUANG Li-bin 建德市中西医结合医院骨科, 浙江 建德 311600 Department of Orthopaedics, Jiande Hospital of Integrated Traditional Chinese and Western Medicine, Jiande 311600, Zhejiang, China huanglibin1121@163.com 
期刊信息:《中国骨伤》2023年36卷,第5期,第420-427页
DOI:10.12200/j.issn.1003-0034.2023.05.005


目的:比较斜外侧腰椎椎间融合术(oblique lateral interbody fusion,OLIF)和经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)在治疗单节段退行性腰椎管狭窄症的疗效及肌肉损伤影像学比较。

方法:对2018年1月至2019年10月采用外科治疗的60例单节段退行性腰椎管狭窄症患者进行回顾性分析,根据手术方式将患者分为OLIF组和TLIF组,每组30例。其中OLIF组采用OLIF+后路肌间隙钉棒内固定术治疗,其中男13例,女17例,年龄52~74(62.6±8.3)岁;TLIF组采用左侧入路TLIF治疗,男14例,女16例,年龄50~81(61.7±10.4)岁。记录两组患者的一般资料,包括手术时间、术中出血量、术后引流量、并发症;观察影像学资料,包括椎间隙高度(disc height,DH),左侧腰大肌、多裂肌、最长肌面积,T2加权像高信号改变及椎间融合情况;分析实验室指标,包括术后第1、5天肌酸激酶(creatine kinase,CK)值;评定临床疗效,根据术后不同时期腰腿疼视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评定疗效。

结果:两组手术时间差异无统计学意义(P>0.05)。OLIF组术中出血量及术后引流量明显少于TLIF组(P<0.01)。OLIF组术后DH恢复优于TLIF组(P<0.05)。OLIF手术组术前与术后左侧腰大肌面积及高信号程度测量比较差异无统计学意义(P>0.05)。术后OLIF组左多裂肌面积与左最长肌面积及左多裂肌与左最长肌Mean值低于TLIF组(P<0.05)。OLIF组术后第1、5天CK较TLIF组低(P<0.05)。术后第3天OLIF组腰背痛及下肢痛VAS低于TLIF组(P<0.05)。术后12个月ODI及术后3、6、12个月VAS比较,差异无统计学意义(P>0.05)。OLIF组术后有1例出现左下肢皮温升高,考虑术中损伤交感链;2例出现左大腿前方麻木,考虑与腰大肌牵拉有关,并发症发生率10%(3/30)。TLIF组术后1例患者踝关节背伸受限,考虑神经根牵拉有关;2例出现脑脊液漏,术中导致硬膜囊撕裂;1例出现切口脂肪液化,考虑椎旁肌剥离损伤有关,并发症发生率13%(4/30)。两组患者随访过程中6个月时椎间全部融合,无融合器塌陷。

结论: OLIF与TLIF均能有效治疗单节段退行性腰椎管狭窄。但OLIF手术术中出血更少,术后疼痛较轻,DH恢复较TLIF有明显优势。同时从实验室指标CK变化及影像学左侧腰大肌、多裂肌、最长肌面积及T2像高信号比较,可以看出OLIF术式对肌肉损伤及干扰程度低于TLIF。
[关键词]:退行性腰椎椎管狭窄症  脊柱融合术  斜外侧腰椎椎间融合术  经椎间孔腰椎椎间融合术
 
Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis
Abstract:

Objective To compare the efficacy and muscle injury imaging between oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis.

Methods The clinical data of 60 patients with single-segment degenerative lumbar spinal stenosis who underwent surgical treatment from January 2018 to October 2019 was retrospectively analyzed. The patients were divided into OLIF groups and TLIF group according to different surgical methods. The 30 patients in the OLIF group were treated with OLIF plus posterior intermuscular screw rod internal fixation. There were 13 males and 17 females,aged from 52 to 74 years old with an average of (62.6±8.3) years old. And 30 patients in the TLIF group were treated with TLIF via the left approach. There were 14 males and 16 females,aged from 50 to 81 years old with an average of (61.7±10.4) years old. General data including operative time,intraoperative blood loss,postoperative drainage volume,and complications were recorded for both groups. Radiologic data including disc height (DH),the left psoas major muscle,multifidus muscle,longissimus muscle area,T2-weighted image hyperintensity changes and interbody fusion or nonfusion were observed. Laboratory parameters including creatine kinase (CK) values on postoperative 1st and 5th days were analyzed. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to assess clinical efficacy.

Results There was no significant difference in the operative time between two groups(P>0.05). The OLIF group had significantly less intraoperative blood loss and postoperative drainage volume compared to the TLIF group(P<0.01). The OLIF group also had DH better recovery compared to the TLIF group (P<0.05). There were no significant differences in left psoas major muscle area and the hyperintensity degree before and after the operation in the OLIF group (P>0.05). Postoperativly,the area of the left multifidus muscle and longissimus muscle,as well as the mean of the left multifidus muscle and longissimus muscle in the OLIF group,were lower than those in the TLIF group (P<0.05).On the 1st day and the 5th day after operation,CK level in the OLIF group was lower than that in the TLIF group(P<0.05). On the 3rd day after operation,the VAS of low back pain and leg pain in the OLIF group were lower than those in the TLIF group (P<0.05). There were no significant differences in the ODI of postoperative 12 months,low back and leg pain VAS at 3,6,12 months between the two groups(P>0.05). In the OLIF group,1 case of left lower extremity skin temperature increased after the operation,and the sympathetic chain was considered to be injured during the operation,and 2 cases of left thigh anterior numbness occurred,which was considered to be related to psoas major muscle stretch,resulting in a complication rate of 10% (3/30). In the TLIF group,one patient had limited ankle dorsiflexion,which was related to nerve root traction,two patients had cerebrospinal fluid leakage,and the dural sac was torn during the operation,and one patient had incision fat liquefaction,which was related to paraspinal muscle dissection injury,resulting in a complication rate of 13% (4/30). All patients achieved interbody fusion without cage collapse during the 6-month follow-up.

Conclusion Both OLIF and TLIF are effective in the treatment of single-segment degenerative lumbar spinal stenosis. However,OLIF surgery has obviously advantages,including less intraoperative blood loss,less postoperative pain,and good recovery of intervertebral space height. From the changes in laboratory indexes of CK and the comparison of the left psoas major muscle,multifidus muscle,longissimus muscle area,and high signal intensity of T2 image on imaging,it can be seen that the degree of muscle damage and interference of OLIF surgery is lower than that of TLIF.
KEYWORDS:Degenerative lumbar spinal stenosis  Spinal fusion  Oblique lateral lumbar interbody fusion  Transforaminal lumbar interbody fusion
 
引用本文,请按以下格式著录参考文献:
中文格式:李三标,梅盛前,徐文斌,方向前,范顺武,黄力斌.斜外侧椎间融合术与经椎间孔椎间融合术在治疗单节段退行性椎管狭窄的疗效及肌肉损伤影像学比较[J].中国骨伤,2023,36(5):420~427
英文格式:LI San-biao,MEI Sheng-qian,XU Wen-bin,FANG Xiang-qian,FAN Shun-wu,HUANG Li-bin.Comparison of clinical effect and muscle injury imaging between oblique lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of single-segment degenerative lumbar spinal stenosis[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(5):420~427
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