两种微创融合术治疗退行性腰椎滑脱的比较

Comparison of two minimally invasive lumbar fusion procedures for degenerative lumbar spondylolisthesis

[目的]比较内镜经椎间孔腰椎间融合术(endoscopic transforaminal lumbar interbody fusion,E-TLIF)与斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)治疗退行性腰椎滑脱(degenerative spondylolisthesis,DS)的临床效果。[方法]2019年4月—2021年1月本院手术治疗82例DS患者。根据术前医患沟通结果,41例行E-TLIF术,41例行OLIF术。比较两组围手术期指标、随访及影像资料。[结果]两组患者均顺利完成手术,均未发生严重并发症。OLIF组手术时间、切口总长度、术中失血量、术中透视次数、下地行走时间、住院时间均显著优于E-TLIF组(P<0.05)。OLIF组术后1d时ESR、PCT、β-EP均显著低于E-TLIF组(P<0.05)。随着时间推移,两组VAS评分、ODI评分均显著减少(P<0.05),JOA评分均显著增加(P<0.05),术后1周、术后3个月时OLIF组VAS评分均显著低于E-TLIF组(P<0.05),术后相应时间点,两组间ODI、JOA评分的差异均无统计学意义(P>0.05)。影像方面,与术前相比,术后两组椎间隙高度、腰椎前凸角均显著增加(P<0.05)。术后3个月、末次随访时OLIF组椎间隙高度、胸椎前凸角均显著高于E-TLIF组(P<0.05)。相应时间点两组椎体滑脱率、Lenke融合评级的差异无统计学意义(P>0.05)。[结论]两种手术方式治疗DS患者具有相似的治疗效果,但OLIF具有出血少、恢复快、创伤小、对血清指标影响小的优势。

[Objective]To compare the clinical outcomes of endoscopic transforaminal lumbar interbody fusion(E-TLIF)versus oblique lumbar interbody fusion(OLIF)for degenerative spondylolisthesis(DS).[Methods]From April 2019 to January 2021,82 patients with DS were surgically treated in our hospital.According to preoperative doctor-patient communication,41 patients underwent E-TLIF,while the remaining 41 patients received OLIF.The perioperative,follow-up and imaging data were compared between the two groups.[Re⁃sults]All patients in both groups had operation performed successfully without serious complications.The OLIF group proved significantly superior to the E-TLIF group in terms of operation time,total incision length,intraoperative blood loss,intraoperative fluoroscopy times,walking time and hospital stay(P<0.05).In addition,the OLIF group had significantly lower ESR,PCT andβ-EP than the E-TLIF group at 1 day after operation(P<0.05).The VAS and ODI scores decreased significantly(P<0.05),while the JOA scores significantly increased over time in both groups(P<0.05).The OLIF group was marked significantly lower VAS score than the E-TLIF group at 1 week and 3 months af⁃ter operation(P<0.05),whereas there were no significant differences in ODI and JOA scores between the two groups at any corresponding time points postoperatively(P>0.05).In terms of imaging,the intervertebral space height and lumbar lordotic angle significantly increased in both groups after surgery compared with those preoperatively(P<0.05),which in the OLIF group were significantly higher than those in the E-TLIF group at 3 months and latest follow-up(P<0.05).There was no significant difference in vertebral slippage percentage and Lenke grade for intervertebral fusion between the two groups at corresponding time points(P>0.05).[Conclusion]Both E-TLIF and OLIF are ef⁃fective treatment for DS.By comparison,the OLIF has advantages of less bleeding,faster recovery,less trauma,and less impact on serum markers over the E-TLIF.