斜外侧入路和经椎间孔入路椎间融合术治疗单节段腰椎滑脱的近期疗效的比较

Comparison of the short-term effects of oblique lateral approach and transforaminal approach for treating single-segment lumbar spondylolisthesis

目的比较斜外侧入路(OLIF)与经椎间孔入路椎间融合术(TLIF)治疗单节段腰椎滑脱的近期临床疗效。方法回顾性分析2019年1月至2020年2月符合纳入标准的68例腰椎滑脱患者资料。根据手术入路不同,分为OLIF+侧方钉板固定(33例)和TLIF+后路椎弓根螺钉固定组(35例)。比较两组患者的手术时间、失血量、术后住院日及并发症发生率,测量手术前后及随访时手术节段的椎间隙高度(DH)、腰椎前凸角(LL)、融合节段前凸角(FSL)、椎间孔高度(FH)、滑脱角(SA)。采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价近期临床疗效。结果关于手术时间、术中出血量、术后引流量及术后住院日,OLIF组均少于TLIF组(均P<0.05)。两组术后VAS和ODI均显著好转,末次随访时两组比较差异无统计学意义(均P>0.05)。术后DH、FH两组比较差异有统计学意义(P<0.05),术后LL、FSL、SA两组比较差异无统计学意义(均P>0.05)。OLIF组有6例(18.2%)出现并发症,TLIF组5例(14.3%)出现并发症,差异无统计学意义(P>0.05)。结论 OLIF和TLIF治疗单节段腰椎滑脱同样安全、有效,但OLIF联合侧方钉板内固定具有手术创伤小、失血少、手术时间短、术后住院日短及康复时间快等优势,是一种更加微创的手术选择。

Objective To compare the short-term clinical effects of oblique lateral interbody fusion(OLIF)and transforaminal lumbar interbody fusion(TLIF) for treating single-segment lumbar spondylolisthesis. Methods We retrospectively analyzed the data of 68 patients with single-segment degenerative lumbar spondylolisthesis from January 2019 to February 2020. According to different surgical methods, the patients were divided into OLIF+ anterior screw fixation group(33 cases)and TLIF + posterior pedicle screw fixation group(35 cases). The operation time,intraoperative blood loss, postoperative drainage, postoperative hospital stay and complication rate were compared between the two groups of patients. The disc height(DH), lumbar lordosis(LL), fused segmental lordosis(FSL), foraminal height(FH), and spondylolisthesis angle(SA) were measured before and after surgery and during follow-up. The visual analogue scale(VAS)of waist pain and the Oswestry disability index(ODI)were used to evaluate the short-term clinical efficacy. Results The operation time, intraoperative blood loss, postoperative drainage, and postoperative hospital stay were less in OLIF group than in TLIF group(all P<0. 05). There was no statistically significant difference in VAS or ODI scores between the two groups at the last follow-up after surgery(both P>0. 05). The two groups had statistically significant differences in DH and FH after surgery(P<0. 05), but no significant difference in postoperative LL, FSL or SA(all P>0. 05). There were six(18. 2%)and five(14. 3%)cases of complications in OLIF group and TLIF group,respectively, with no significant difference(P>0. 05). Conclusion OLIF and TLIF are equally safe and effective in treating single-segment lumbar spondylolisthesis. However, OLIF combined with anterior screw fixation has the advantages of less surgical trauma,less blood loss,shorter operation time,reduced postoperative hospital stay and shorter recovery time. Therefore,it is a more minimally invasive surgical option.