后路椎间孔椎体融合术与斜外侧腰椎融合联合后路椎弓根螺钉内固定术对退变性腰椎滑脱的疗效比较

Comparison of the efficacy of transforaminal lumbar interbody fusion and oblique lumbar interbody fusion combined with posterior pedicle screw fixation in the treatment of degenerative lumbar spondylolisthesis

目的:研究治疗退变性腰椎滑脱时分别采用经椎间孔腰椎融合术(TLIF)和斜外侧入路腰椎融合术(OLIF)合并椎弓根螺钉内固定的具体效果。方法:2018年8月至2020年1月期间治疗腰椎滑脱症患者54例,男30例,女24例;按照治疗方法的不同分为TLIF组与OLIF组,以手术时间、术中出血量、术后VAS评分、Oswestry功能障碍指数评分、JOA评分、腰椎前凸角、椎间隙高度变化作为指标,进行组间对比。结果:所有患者手术均成功,两组患者术前术后的疗效均有明显改善(P<0.05),其中OLIF组在手术时间及术中出血量较TLIF组有明显优势(P<0.05);组间进行比较,疗效无明显差异(P>0.05)。全部患者术中并没有损伤血管、神经及术后出现严重并发症等。结论:TLIF与OLIF在治疗退变性腰椎滑脱的具有相似且可靠的疗效,但OLIF手术具有手术时间短、术中少量出血、具有相对较小创伤、间接减压等优势,可以为腰椎滑脱患者的治疗提供新的选择,未来应用前景广阔。

Objective:To explore the specific effects of transforaminal lumbar interbody fusion(TLIF)and oblique lumbar interbody fusion(OLIF)combined with posterior pedicle screw fixation in the treatment of degenerative lumbar spondylolisthesis.Methods:From August 2018 to January 2020,54 patients(30 males)with lumbar spondylolisthesis were included in this study.According to the different treatment methods,they were divided into TLIF group and OLIF group,and the operation time,intraoperative blood loss,postoperative VAS score,Oswestry dysfunction index score,JOA score,lumbar lordosis angle,and intervertebral space height changes were compared between the two groups.Results:All patients were successfully operated,the curative effect of the two groups of patients were significantly improved after operation with significant difference(P<0.05),the OLIF group had obvious advantages in the operation time and intraoperative blood loss as compared with TLIF group(P<0.05).No significant difference was found in curative effect between the two groups(P>0.05).All patients showed no damages in blood vessels and nerves,or serious postoperative complications during the operation.Conclusion:TLIF and OLIF have similar and reliable effects in the treatment of degenerative lumbar spondylolisthesis,but OLIF surgery has the advantages of short operative time,small amount of intraoperative bleeding,relatively small trauma,indirect decompression,etc.,and is more valuable for the future application.