OLIF联合后路固定手术治疗腰椎退行性病变疗效及功能恢复研究

Efficacy of oblique lateral interboy fusion combined with posterior fixed surgery in the treatment of lumbar degenerative disease and the functional recovery

目的探讨斜外侧腰椎椎间融合术(OLIF)联合后路固定手术治疗腰椎退行性病变的疗效及功能恢复情况,为患者治疗提供临床指导。方法选择2017年2月至2019年2月在渭南市第一医院骨科施行手术治疗的115例患者作为研究对象,按照随机数表法分为观察组63例和对照组62例。对照组患者采取OLIF治疗,观察组患者则采取OLIF联合后路固定手术治疗。比较两组患者的手术时间、术中出血量、术后下床时间、住院时间和术后并发症;随访3个月,采用视觉疼痛模拟评分(VAS)、腰椎功能评分(JOA)和Oswestry功能障碍指数(ODI)评分评价疗效,根据影像学检查结果评估功能恢复情况。结果观察组患者的手术时间和术后下床时间分别为(140.33±22.47)min、(2.03±0.89)d,明显长于对照组的(92.55±13.88)min,(1.08±1.01)d,术中出血量为(200.31±61.14)mL,明显多于对照组的(78.29±27.91)mL,差异均有统计学意义(P<0.05);术后3个月,对照组和观察组患者的VAS评分均明显降低,JOA评分都明显升高,且观察组患者VAS评分明显低于对照组[(1.99±0.89)分vs(2.53±0.77)分],JOA评分明显高于对照组[(19.33±2.08)分vs(18.79±2.15)分],差异均有统计学意义(P<0.05);对照组和观察组术后3 d的ODI评分[(60.31±9.36)分、(56.25±8.18)分]和3个月的ODI评分[(41.26±8.38)分、(31.27±8.09)分]明显低于术前[(70.11±10.21)分、(69.33±10.03)分],且观察组明显低于对照组,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为4.76%,略低于对照组的8.06%,但差异无统计学意义(P>0.05);术后3 d和3个月,两组患者的椎间隙高度及椎间孔面积均明显升高,且观察组的椎间孔面积明显高于对照组,差异均有统计学意义(P<0.05),但两组患者的椎间隙高度比较差异无统计学意义(P>0.05)。结论OLIF联合后路固定手术治疗腰椎退行性疾病疗效显著,术后并发症少,腰腿疼痛减轻,功能评分、椎间隙高度和椎间孔面积均提高,更有利于促进腰腿功能恢复。

【Abstract】Objective To investigate the efficacy of oblique lateral lumbar interbody fusion(OLIF)combined with posterior fixation surgery in the treatment of lumbar degenerative disease and the functional recovery of the patients,in order to provide clinical guidance for patients.Methods A total of 115 patients who underwent surgery in Department of Orthopaedics of First Hospital of Weinan City from February 2017 to February 2019 were enrolled in the study.According to the random number table method,the patients were divided into observation group(63 patients)and control group(62 patients)to receive OLIF combined with posterior fixed surgery or OLIF surgery only,respectively.The operation time,intraoperative blood loss,time of off-bed activity after operation,length of hospital stay,and postoperative complications were compared between the two groups.After 3 months of follow-up,the Visual Analogue Scale(VAS),Japanese Orthopedic Association(JOA),and Oswestry disability index(ODI)scores were used to assess the efficacy,and the functional recovery was evaluated based on imaging findings.Results The operation time and time of off-bed activity after operation were(140.33±22.47)min and(2.03±0.89)d in the observation group,significantly higher than(92.55±13.88)min and(1.08±1.01)d in the control group(P<0.05),and the intraoperative blood loss was(200.31±61.14)mL in the observation group,significantly more than(78.29±27.91)mL in the control group(P<0.05).Three months after operation,the VAS score of the patients in the control group and the observation group decreased significantly,and the JOA score increased significantly;the VAS score of the patients in the observation group was significantly lower than that of the control group:(1.99±0.89)points vs(2.53±0.77)points,and the JOA score was significantly higher than that of the control group:(19.33±2.08)points vs(18.79±2.15)points;the differences were all statistically significant(P<0.05).The ODI scores of control group and observation group were(60.31±9.36)points and(56.25±8.18)points on the 3rd day after operation and(41.26±8.38)points and(31.27±8.09)points three months after operation,which were significantly lower than(70.11±10.21)points and(69.33±10.03)points before operation,and the scores of observation group were significantly lower than those of the control group(P<0.05).The incidence of complications in the observation group was 4.76%,slightly lower than 8.06%in the control group(P>0.05).Three days and 3 months after operation,the height of intervertebral space and the area of intervertebral foramen in the two groups increased significantly(P<0.05),and the area of intervertebral foramen in the observation group was significantly higher than that in the control group(P<0.05),but there were no significant difference in the height of intervertebral space between the two groups(P>0.05).Conclusion OLIF combined with posterior fixed surgery for the treatment of lumbar degenerative diseases has significant curative effect.It reduces postoperative complications,lowers back pain,increases functional score,improves intervertebral space height and intervertebral foramen area,and ultimately promotes recovery of lumbar and leg function.