摘要
目的比较斜外侧腰椎椎间融合术(oblique lateral interbody fusion,OLIF)与经皮脊柱内镜辅助下腰椎后路融合术(percutaneous transforaminal endoscope-assisted posterior lumbar interbody fusion,PT-Endo-TLIF)治疗退行性腰椎滑脱的临床疗效及观察腰椎矢状位参数的变化。方法回顾性分析2017年9月至2020年1月经新疆医科大学第四附属医院诊断为退行性腰椎滑脱(Meyerding分型Ⅰ~Ⅱ°)并行手术治疗的43例患者。其中23例患者采用OLIF术式治疗,20例患者采用PT-Endo-TLIF术式治疗。观察且记录两组患者的手术时间、平均住院时间、术中出血量、术后并发症情况。术后定期(术后3 d、术后6个月、12个月)复查腰椎X线片、CT或MRI检查进行影像学评估,并比较观察两组患者术后的矢状位参数的变化。用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评估疗效。结果两组患者均顺利完成手术并随访,平均随访时间为12个月。OLIF组术中平均出血量、手术时间少于PT-Endo-TLIF组,两组间具有统计学差异(P<0.05)。与术前相比,两组术后椎间高度增加(P<0.05),两组间差异有统计学意义(P<0.05)。与术前相比,两组的腰椎前凸角、下腰椎前凸角、腰椎前凸分布指数均有增加(P<0.05),但两组间差异无统计学意义(P>0.05)。两组患者腰4(L_(4))椎体倾斜角、L_(1)垂线与骶1(S_(1))距离均较术前减小(P<0.05),但两组间差异无统计学意义(P>0.05)。两组患者L_(5)椎体倾斜角较术前增加(P<0.05),两组间差异无统计学意义(P>0.05)。结论腰椎退行性滑脱的手术治疗,OLIF和PT-Endo-TLIF两种手术方式均有良好的临床疗效。与PT-Endo-TLIF比较,OLIF具有手术时间短、术中出血少、椎间隙高度恢复更好等优势,适合临床医师广泛开展。
Objective To compare the clinical efficacy and sagittal parameters of oblique lateral interbody fusion(OLIF)combined with posterior percutaneous internal fixation and percutaneous transforaminal endoscope-assisted posterior lumbar interbody fusion(PT-Endo-TLIF)in treating degenerative lumbar spondylolisthesis.Methods A retrospective analysis was made on 43 patients with MeyerdingⅠandⅡ°degenerative lumbar spondylolisthesis treated in our hospital from September 2017 to January 2020.Among them 23 cases were treated by OLIF,and the other 20 cases were treated by PT-Endo-TLIF.We observed and recorded the operation time,average length of hospital stay,and intraoperative blood loss,and postoperative complications of the patients.The patients were followed up 3 day,6 and 12 months after the operation.The lumbar sagittal parameters of the two groups were compared by X-ray,CT and MRI examinations.The patients’lower back pain was recorded for visual analogue scale(VAS),and Oswestry disability index(ODI)was used to evaluate the clinical efficacy.Results Both groups of patients successfully completed the operation and follow-up,with the average follow-up time of 12 months.The average amount of intraoperative blood loss and operation time were significantly lower in OLIF group than in PT-Endo-TLIF group(P<0.05).Intervertebral height increased significantly in the two groups after operation compared with pre-operation(P<0.05).Compared with preoperation,lumbar lordosis angle,lower lumbar lordosis angle and lumbar lordosis distribution index increased in both groups(P<0.05),with no significant difference between them(P>0.05).The inclination angle of L4 vertebral body and the distance between L_(1) vertical line and S_(1) in both groups were decreased compared with those before surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).The inclination angle of L5 vertebral body in the two groups was increased compared with that before surgery(P<0.05),but there was no statistical significance between both groups(P>0.05).Conclusion OLIF surgical technique has the comparative advantages of definite curative effect,less trauma,fewer surgical complications,shorter operation time,less bleeding,and good recovery of the height of intervertebral space,which is suitable for its application among clinicians.
作者
李建江
白涛
胡炜
黄异飞
韩念荣
LI Jianjiang;BAI Tao;HU Wei;HUANG Yifei;HAN Nianrong(The Fourth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2022年第1期105-110,共6页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
新疆维吾尔自治区自然科学基金(No.2020D01C145)。
关键词
腰椎退变性滑脱
斜外侧腰椎间融合术
经皮脊柱内镜辅助下腰椎后路融合术
矢状位参数
degenerative spondylolisthesis of the lumbar spine
oblique lateral interbody fusion
percutaneous transforaminal endoscope-assisted lumbar interbody fusion
sagittal parameter
作者简介
通信作者:黄异飞,主任医师.E-mail:jerkhuang@163.com。
