摘要
目的 探讨经椎间孔腰椎椎间融合术(TLIF)与斜外侧腰椎椎间融合术(OLIF)联合后路椎弓根螺钉内固定术治疗退变性腰椎滑脱症的疗效和安全性。方法 本研究为回顾性分析,选取西安医学院第二附属医院脊柱外科2021年1月~2023年2月收治的符合纳入标准的退变性腰椎滑脱症病人65例。根据手术方法将病人分为OLIF联合后路椎弓根螺钉内固定组(30例)和TLIF联合后路椎弓根螺钉内固定组(35例)。比较两组围手术期情况(手术时间、术中出血量等),并对手术前后的腰痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分、改良Macnab标准评分及影像学指标(椎间隙高度、椎间孔高度、腰椎前凸角度、融合节段前凸角度和椎体滑脱率)进行比较。结果 两组病人均完成6个月的随访。OLIF组术中出血量(57.79±11.54)ml,术后住院时间(5.85±0.94)天,TLIF组分别为(150.57±29.68)ml和(6.76±1.13)天,两组比较差异有统计学意义(P<0.05)。OLIF组术后3天的VAS评分(1.50±0.61)分,ODI指数(17.06±2.92)%,JOA评分(12.06±2.90)分,TLIF组分别为(2.05±0.72)分,(26.41±3.38)%和(10.24±2.68)分,两组比较差异有统计学意义(P<0.05)。OLIF组术后3天的椎间隙高度(14.43±1.50)mm,椎间孔高度(23.87±1.41)mm,TLIF组分别为(13.66±1.12)mm和(23.14±1.39)mm,两组比较差异有统计学意义(P<0.05)。OLIF组术后3个月的椎间隙高度(13.42±1.41)mm,椎间孔高度(23.34±1.33)mm,TLIF组分别为(12.63±1.33)mm和(22.42±1.40)mm,两组比较差异有统计学意义(P<0.05)。两组术后6个月的VAS评分、ODI指数、JOA评分、改良Macnab标准评分及椎间隙高度、椎间孔高度比较,差异无统计学意义(P>0.05)。术后3天至6个月,两组在腰椎前凸角、融合节段前凸角和腰椎滑脱率比较,差异无统计学意义(P>0.05)。结论 OLIF联合后路椎弓根螺钉内固定术在短期内可能提供更好的围手术期疗效,尤其在术中出血量和术后疼痛控制方面优于TLIF。两组短期疗效比较无明显差异。
Objective To evaluate the efficacy and safety of transforaminal lumbar interbody fusion(TLIF)and oblique lateral interbody fusion(OLIF)combined with posterior pedicle screw fixation in treating degenerative lumbar spondylolisthesis.Methods This retrospective analysis included 65 patients with degenerative lumbar spondylolisthesis treated at the Second Affiliated Hospital of Xi’an Medical University’s Department of Spine Surgery from January 2021 to February 2023.Patients were divided into two groups based on the surgical method:30 patients underwent OLIF combined with posterior pedicle screw fixation,and 35 patients underwent TLIF combined with posterior pedicle screw fixation.Perioperative outcomes(surgical time,intraoperative blood loss,etc.)were assessed,along with pre-and post-operative evaluations using the Visual Analog Scale(VAS)for back pain,the Oswestry Disability Index(ODI),the Japanese Orthopaedic Association(JOA)score,the modified Macnab criteria,and radiological parameters(intervertebral disc height,foraminal height,lumbar lordosis angle,fusion segment lordosis angle,and vertebral slip rate).Results Both groups of patients completed a 6-month follow-up.The intraoperative blood loss in the OLIF group was(57.79±11.54)ml,and the postoperative hospital stay was(5.85±0.94)days,while in the TLIF group,the values were(150.57±29.68)ml and(6.76±1.13)days,respectively.The differences between the two groups were statistically significant(P<0.05).The VAS score,ODI index,and JOA score on the 3rd postoperative day in the OLIF group were(1.50±0.61)points,(17.06±2.92)%,and(12.06±2.90)points,respectively,while in the TLIF group,they were(2.05±0.72)points,(26.41±3.38)%,and(10.24±2.68)points.The differences between the two groups were statistically significant(P<0.05).The intervertebral space height and foramen height on the 3rd postoperative day in the OLIF group were(14.43±1.50)mm and(23.87±1.41)mm,respectively,while in the TLIF group,they were(13.66±1.12)mm and(23.14±1.39)mm.The differences between the two groups were statistically significant(P<0.05).At 3 months postoperatively,the intervertebral space height and foramen height in the OLIF group were(13.42±1.41)mm and(23.34±1.33)mm,while in the TLIF group,they were(12.63±1.33)mm and(22.42±1.40)mm.The differences between the two groups were statistically significant(P<0.05).However,there were no statistically significant differences between the two groups in VAS score,ODI index,JOA score,modified Macnab criteria score,intervertebral space height,or foramen height at 6 months postoperatively(all P>0.05).From the 3rd postoperative day to 6 months,there were no statistically significant differences between the two groups in lumbar lordosis angle,segmental lordosis angle,or vertebral slippage rate(all P>0.05).Conclusion OLIF combined with posterior pedicle screw fixation may provide better short-term perioperative outcomes,particularly in terms of intraoperative blood loss and postoperative pain control,compared to TLIF.However,there were no significant differences in short-term outcomes between the two methods.
作者
姚亚波
周鹏飞
YAO Yabo;ZHOU Pengfei(Department of Spine Surgery,Second Affiliated Hospital of Xi’an Medical University,Xi’an 710038,China)
出处
《临床外科杂志》
2025年第5期535-539,共5页
Journal of Clinical Surgery
基金
陕西省重点研发计划项目(2020SF-095)。
关键词
腰椎滑脱症
经椎间孔腰椎椎间融合术
斜外侧腰椎椎间融合术
后路椎弓根螺钉内固定
退变性腰椎病
围手术期评估
lumbar spondylolisthesis
transforaminal lumbar interbody fusion
oblique lateral interbody fusion
posterior pedicle screw fixation
degenerative lumbar disease
perioperative assessment
作者简介
通信作者:周鹏飞,Email:m13186042843@163.com。
