两种椎间融合术治疗单节段腰椎退行性疾病的疗效比较

Comparison of two kinds of interbody fusion in the treatment of single-level lumbar degenerative diseases

目的 比较斜外侧腰椎椎间融合术(OLIF)与微创经椎间孔椎间融合术(MIS-TLIF)治疗单节段腰椎退行性疾病的疗效。方法 将40例非手术治疗无效的单节段腰椎退行性疾病患者根据治疗方式不同分为OLIF组(采用OLIF治疗,20例)和MIS-TLIF组(采用MIS-TLIF治疗,20例)。记录两组手术情况,测量手术前后腰椎前凸角和椎间隙高度,采用JOA评分、疼痛VAS评分及ODI评估手术效果。结果 患者均获得随访,时间12~16个月。手术时间、术中出血量OLIF组短(少)于MIS-TLIF组(P<0.05)。椎间隙高度、腰椎前凸角、疼痛VAS评分、ODI、JOA评分两组术后均较术前改善(P<0.05),术后椎间隙高度、腰椎前凸角OLIF组均优于MIS-TLIF组(P<0.001),术后疼痛VAS评分、ODI、JOA评分两组比较差异均无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论 OLIF与MIS-TLIF治疗单节段腰椎退行性疾病均能取得满意的疗效,OLIF术中出血量更少,在恢复腰椎前凸角及椎间隙高度方面更有优势。

Objective To compare the efficacy of oblique lumbar interbody fusion(OLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single-level lumbar degenerative disease.Methods The 40 patients with single-level lumbar degenerative diseases who failed to receive non-surgical treatment were divided into OLIF group(20 cases)and MIS-TLIF group(20 cases),according to different treatment methods.The operation conditions were recorded.Lumbar lordosis angle and intervertebral space height were measured before and after surgery.The results of surgery were evaluated by JOA score,pain VAS and ODI.Results All patients were followed up for 12~16 months.Operation time and intraoperative blood loss in the OLIF group were shorter(less)than those in the MIS-TLIF group(P<0.05).After surgery,the intervertebral space height,lumbar lordosis angle,pain VAS,ODI score and JOA score were improved than the preoperation(P<0.05).OLIF group had better intervertebral space height and lumbar lordosis angle than MIS-TLIF group after surgery(P<0.001).There were not statistical differences in postoperative pain VAS,ODI score and JOA score between the two groups(P>0.05).There was no statistical difference in the incidence of complications between the two groups(P>0.05).Conclusions Both OLIF and MIS-TLIF can achieve satisfactory clinical efficacy in the treatment of single-level lumbar degenerative diseases.OLIF has less intraoperative blood loss,more advantages in restoring lumbar lordosis angle and intervertebral space height.