斜外侧腰椎椎间融合术联合后路固定与单独应用对退行性滑脱节段力线改善效果的比较

Comparison of segmental alignment outcomes in lumbar degenerative spondylolisthesis after single OLIF and OLIF with posterior fixation

目的探讨斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)联合后路固定与单纯OLIF手术对腰椎退行性滑脱(degenerative spondylolisthesis,DS)患者节段力线的影响。方法连续性收集并回顾性分析2017年7月至2019年12月63例(73个节段)接受OLIF手术且未行后路截骨术的DS患者的资料。单纯OLIF手术17例,OLIF手术联合后路固定46例;单节段手术53例,双节段手术10例。所有患者于术前与术后3 d行腰椎标准站立位侧位X线片检查,并测量椎间高度(disc height,DH)、滑移率(slip ratio,SR)和节段前凸角度(segmental lordosis,SL)等。结果73个手术节段中,单纯OLIF组21个、OLIF联合后路固定组52个。两组小关节退变程度、融合节段和融合器位置差异无统计学意义。在节段力线方面,单纯OLIF组与OLIF联合后路固定组SL改善1.5°、5.0°,SR改善约5.3%和11.6%,差异有统计学意义(P<0.001)。OLIF联合后路固定组SL、SR较单纯OLIF组分别提高3.5°、6.3%。结论OLIF手术联合后路固定对DS患者节段力线的改善效果优于单纯OLIF手术,尤其是SR和SL改善效果更好。

Objective To compare radiographic outcomes of segmental alignment of patients with lumbar degenerative spondylolisthesis(DS)after single technique and combined posterior fixation in oblique lumbar interbody fusion(OLIF)procedure,and to evaluate the effect of posterior fixation on lumbar segmental alignment.Methods A total of 63 patients(73 DS segments)with DS underwent OLIF surgery without posterior osteotomy with or without additional posterior fixation from July 2017 to December 2019 were selected.Seventeen patients were treated with single OLIF and 46 patients were treated with OLIF combined with posterior fixation.There were 53 patients underwent single-level surgery and 10 patients underwent double-level surgery.The radiographic parameters including disc height(DH),slip ratio(SR),and segmental lordosis(SL)were measured on plain radiographs before operation and 3 d after operation.Results These were 21,52 segments in single OLIF and OLIF combined with posterior fixation groups,respectively.There was no significant difference among facet degeneration,level fused,and cage position between the two groups.In single OLIF and OLIF combined with posterior fixation groups,SL about improved 1.5°and 5.0°,and SR about improved 5.3%and 11.6%,respectively(P<0.001).SL improved 3.5°and SR improved 6.3%by posterior fixation based on OLIF.Conclusions OLIF combinded with posterior fixation has better improvement effect on radiographic parameters in DS patients than single OLIF,especially in SR and SL.