成人单节段退行性腰椎侧弯两种融合术比较

Comparison of two interbody fusions for single-segment degenerative lumbar scoliosis in adult

[目的]对比斜外侧入路椎间融合术(oblique lateral interbody fusion,OLIF)与经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗成人单节段退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)的疗效。[方法]回顾性分析112例成人单节段DLS患者的临床资料,依据术前医患沟通结果将患者分为两组,其中,OLIF组51例,TLIF组61例。比较两组围手术期、随访与影像资料。[结果]所有患者均顺利完成手术。两组的手术时间和透视次数比较差异无统计学意义(P>0.05);OLIF组手术切口长度、术中出血量及术后住院时间均显著低于TLIF组(P<0.05)。OLIF组术后下地行走与完全负重活动时间均显著早于TLIF组(P<0.05)。随时间推移,两组的VAS评分和ODI显著降低(P<0.05),而SF-12 PCS评分显著增加(P<0.05)。术后1周,OLIF组VAS、ODI和SF-12 PCS方面均显著优于TLIF组(P<0.05)。影像学方面,术后OLIF组的SVA、LL、PT、CA和CBD均显著优于TLIF组(P<0.05)。至末次随访时,不良影像表现OLIF组为13.72%(7/51);TLIF组为37.70%(23/61),两组间差异有统计学意义(P<0.05)。[结论]OLIF治疗成人单节段DLS创伤小、术后恢复快,可减少矢状面并发症并改善患者的生活质量。

[Objective] To compare the efficacy of oblique lateral interbody fusion(OLIF) and transforaminal lumbar interbody fusion(TLIF) in the treatment of single-segment degenerative lumbar scoliosis(DLS) in adult. [Methods] A retrospective study was done on 112 adult patients who underwent surgical treatment for single-segment DLS. Based on the results of preoperative doctor-patient communication,the patients were divided into two groups, including 51 cases in the OLIF group and 61 cases in the TLIF group. The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had operation completed successfully. There was no statistically significant difference in the operation time and the number of intraoperative fluoroscopy between the two groups(P>0.05), the OLIF group proved significantly superior to the TLIF group in terms of surgical incision length, intraoperative blood loss and postoperative hospital stay(P<0.05). The OLIF group resumed walking and full weight-bearing activities significantly earlier than the TLIF group(P<0.05). The VAS score and ODI decreased significantly(P<0.05), while the SF-12 PCS increased significantly in both groups over time(P<0.05). At one week after operation, the OLIF group was significantly better than the TLIF group in terms of VAS,ODI and SF-12 PCS(P<0.05). With respect of imaging, the OLIF group were significantly better than the TLIF group regarding to sagittal vertical axis(SVA), lumbar lordosis(LL), pelvic tilt(PT), Cobb’s angle of scoliosis(CA) and coronal balance distance(CBD). By the time of the last follow-up, the total adverse imaging findings were 13.72%(7/51) in the OLIF group, whereas 37.70%(23/61) in the TLIF group, which was statistically significant(P<0.05). [Conclusion] The OLIF for treatment of single-segment DLS in adult has benefits of less trauma and quick recovery after surgery, which can reduce sagittal complications and improve the quality of life of patients.