腰椎斜外侧椎体间融合术与腰椎后路椎体间融合术治疗腰椎滑脱症创伤反应的对比研究

Comparison the postoperative wound reaction of the lumbar spondylolithesis treatment by OLIF and PLIF

目的探讨腰椎斜外侧椎体间融合术(OLIF)与腰椎后路椎体间融合术(PLIF)治疗腰椎滑脱症的创伤反应。方法选取2014年8月至2015年2月于某院治疗的52例腰椎滑脱症患者进行临床对照研究,其中OLIF手术(A组)治疗者17例,PLIF手术(B组)治疗者35例,观察并比较两组患者切口长度、术中出血量、术后住院时间等相关围手术期指标,比较两组患者术前1d及术后12、24、48h抽取末梢静脉血检测的C反应蛋白(CRP)及肌酸激酶浓度(CK),应用视觉模拟评分(VAS)分别于术后第1、2、3天评估两组患者术后切口疼痛情况,并同时评估术前及术后1、2、3d腰腿痛情况。结果两组患者一般资料差异无统计学意义(P>0.05)。两组术后腰腿痛VAS评分均低于术前,两组间无明显差异(P>0.05),手术切口长度、术中失血量、住院时间方面A组患者均低于B组,差异具有统计学意义(P<0.05)。两组术后不同时间段血清CRP及CK浓度均较术前不同程度的增高;两组间比较,A组升高幅度明显低于B组,差异有统计学意义(P<0.05);两组术后1~3d切口疼痛VAS评分均不同程度下降,两组间比较A组评分明显低于B组,差异有统计学意义(P<0.05)。结论 OLIF与PLIF治疗腰椎滑脱症均可获得满意疗效,但OLIF有出血少、创伤小、恢复快、机体创伤应激反应更小等优点。

Objective To explore and comparison the trauma responses of the lumbar fusion between oblique vertebral body （OLIF） and traditional PLIF technique for the treatment of lumbar olisthe disease. MethOds Fifty-two patients were enrolled by the entry criteria between August 2014 and February 2015 in our hospital,and were assigned to using the oblique vertebral fusion between （OLIF group,n= 17） and posterior lumbar interbody fusion （PLIF, n= 35）. The length of skin incision, intraoperative blood loss,and post-operative hospital stay were recorded, as well as the serum levels of C-reactive protein （CRP） and creatine kinase（CK）were measured before and the same time after operation. The pain severity of incision in postoperative 1 d, 2 d, 3 d was evaluated by visual analog scale （VAS）. And at the same time to evaluate lumbocrural painpre of operative and postoperative 1 d, 2 d, 3 d. Results Ther6 was no statistically significant difference in the general information in both groups （P〉0.05）, after analysis,the lumbocrural pain VAS score of the two groups were lower than the preoperative and postoperative,there was no significant difference between the two groups （P〉0.05）, but in the incision length, intra-operative blood loss,hospital stay in, patients in group A were lower than group B, there are statistically significant difference （P〈0.05）. The serum levels of CRP and CK were measured 12 h,24 h and 48 h of after operative in group A were lower than group B, with statistical significance （P〈0.05）. Two groups of postoperative 1- 3 d incision pain VAS score were falling,the postoperative 1 3 d VAS score between the group A and B were differences,and A significantly lower than B. they were statistically significant （P〈0. 05）. Conclusion Two groups of surgical way to treat lumbar olisthe disease all can obtain satisfactory curative effect. But OLIF surgery not only can ensure the curative effect,also have the advantage of less bleeding,local symptom is light, quick recovery, cause tissue damage and system traumatic stress reaction is lighter.