显微镜辅助下侧前方腰椎融合术与改良经椎间孔入路腰椎融合术治疗退变性腰椎管狭窄症的疗效

OLIF versus Mis-TLIF assisted by microscope for degenerative lumbar stenosis

目的探讨通道辅助显微镜下侧前方腰椎融合术(oblique lumbar interbody fusion,OLIF)与改良经椎间孔入路腰椎间融合术(minimally invasive transforaminal lumbar interbody fusion,Mis-TLIF)治疗退行性腰椎管狭窄症的临床治疗效果。方法选择2017年3月至2019年3月南华大学附属长沙中心医院收治的120例退变性腰椎管狭窄症患者,按照手术方式不同分为OLIF组和Mis-TLIF组各60例,比较2组手术时间、术中出血量、住院时间。记录两组术前、术后1周和术后3、6个月疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),比较两组患者疼痛评分、功能恢复、临床疗效和并发症情况。采用改良MacNab标准比较两组的临床疗效。结果与Mis-TLIF组比较,OLIF组的术中出血量、住院时间和术后并发症均明显更短或更少,组间差异有统计学意义(P<0.05)。与治疗前比较,两组治疗后VAS评分与ODI评分明显改善(P<0.05),且治疗6个月后两组间ODI评分比较差异有统计学意义(P<0.05)。两组患者末次随访改良MacNab标准优良率相比差异无统计学意义(P>0.05)。结论相对Mis-TLIF而言,OLIF手术具有安全可行、出血少、恢复快的优势,能有效治疗退变性腰椎管狭窄症。

Objective To investigate the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion and oblique lumbar interbody fusion by microscope assisted for degenerative lumbar stenosis.Method A total of 120 patients with degenerative lumbar stenosis were selected from March 2017 to March 2019 and were assigned to minimally invasive transforaminal lumbar interbody fusion group(Mis-TLIF group)and oblique lumbar interbody fusion group(OLIF group).Parameters including operative duration,hemorrhage volume and perioperative complications were collected.The therapeutic effects were assessed by visual analogue scale,Oswestry disability index during follow-up period(postoperative 1 week,3 months and 6 months).The surgical effect was evaluated by the modified MacNab criteria.Results Compared with Mis-TLIF group,the intraoperative blood loss,postoperative hospital stay,and postoperative complications of OLIF group were significantly shorter or less(P<0.05).The VAS score and ODI score of the two groups were all significantly improved after treatment(P<0.05)and there was significant difference in ODI score between two groups(P<0.05).According to the modified MacNab criteria,no significant difference was found between two groups at follow-up(P>0.05).Conclusion Compared with Mis-TLIF,OLIF by microscope assisted was safe and feasible,which not only had less hemorrhage volume,but also shortened the postoperative hospital stay.OLIF by microscope assisted could get satisfying effect in the treatment of degenerative lumbar stenosis.