一期OLIF与TLIF治疗单节段腰椎结核的对比研究

A Comparative Study of One-stage OLIF and TLIF In the Treatment of Single-stage Lumbar Tuberculosis

目的评价斜外侧椎体间融合(oblique lumbar interbody fusion,OLIF)联合后路固定及经椎间孔腰椎椎间融合(transforaminal lumbar interbody fusion,TLIF)治疗腰椎结核(Tuberculosis of lumbar spine)的临床效果。方法回顾性分析2018年1月至2021年5月在新疆维吾尔自治区人民医院骨科脊柱二病区收治的腰椎结核患者126例,最终通过筛查纳入48例病例进行分析。按照不同手术方式分为两组,OLIF组26例,男性12例,女性14例;年龄30~72岁,平均年龄(49.62±16.70)岁;TLIF组22例,男12例,女10例;年龄30~75岁,平均年龄(51.41±15.30)岁。统计手术时间、手术出血量、住院时间、视觉模拟评分(visual analogue scale,VAS)、日常生活活动能力评分(activities of daily living,ADL)、Oswestry功能障碍指数(Oswestry disability index,ODI)、血沉(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)以及并发症等相关参数。结果术后所有患者均通过当地医院或在本院门诊进行随访,平均随访时间(11.50±2.13)个月。两组内VAS评分和ADL评分、ODI指数、ESR、CRP均较术前显著改善且差异性有统计学意义(P<0.05)。OLIF组与TLIF组在手术时间、手术出血量、住院时间、VAS评分及ADL评分、ODI指数、ESR、CRP血液指标改善等方面差异无统计学意义(P>0.05)。OLIF组1例患者出现股神经损伤表现,通过康复理疗(3个月)基本恢复行走能力,3例患者术后出现皮下脂肪液化等情况,经过积极换药、抗炎等治疗后均已痊愈。TLIF组手术患者未出现神经损伤表现,但4例患者出现切口因脂肪液化延迟愈合现象,通过再次手术清创及换药切口Ⅱ期愈合。结论一期OLIF及TLIF治疗单节段腰椎结核均可得到相似的效果。TLIF对于体重不做过多要求,总体学习曲线短,手术方式相对简单,可以在基层单位及年轻医师中开展。OLIF手术对于身体质量指数较大的患者存在一定弱势,但总体具有手术时间短、术中出血少、对中后柱周围组织破坏少、对脊神经激惹小、植骨有效面积大、病灶清除量多等优点。两种手术各有各的特点,因此需根据患者的影像学及病情选择手术方案。

Objective To evaluate the clinical effect of oblique lumbar interbody fusion(OLIF)combined with posterior fixation and transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar tuberculosis.Methods A total of 126 patients with lumbar tuberculosis admitted to the Second Department of Spinal of the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to May 2021 were retrospectively analyzed.48 cases were finally included for analysis.They were divided into two groups according to different surgical methods.The OLIF group(n=26)had 12 male and 14 female patients.The patients aged 30 to 72 years,with a mean age of(49.62±16.70)years.The TLIF group(n=22)had 12 male and 10 female patients.The patients aged 30 to 75 years,with a mean age of(51.41±15.30)years.The operation time,intraoperative blood loss,hospital stay,visual analogue scale(VAS),activities of daily living(ADL),Oswestry disability index(ODI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and complications and other related parameters were counted.Results All patients were followed up in local hospital or outpatient department of our hospital after operation,with an average follow-up time of(11.50±2.13)months.The VAS and ADL,ODI,ESR and CRP in the two groups were significantly improved compared with those before operation,and the differences had statistical significance(P<0.05).There was no significant difference between the OLIF group and the TLIF group in the operation time,intraoperative blood loss,hospital stay,VAS and ADL,ODI,ESR,and CRP blood parameters(P>0.05).1 patient in the OLIF group showed femoral nerve injury,and the walking ability was basically recovered by rehabilitation physiotherapy of 3 months,and 3 patients developed subcutaneous fat liquefaction after surgery,which had recovered after active dressing change and anti-inflammatory treatment.No nerve injury was found in TLIF group,but delayed healing due to fat liquefaction was found in 4 patients,and the incision healed by second operation for debridement and dressing change.Conclusion One-stage OLIF and TLIF can obtain similar results in the treatment of single-level lumbar tuberculosis.TLIF does not have strict requirement of body,has a short overall learning curve,and is relatively simple to perform in primary hospitals and young physicians.However,OLIF has some weaknesses for patients with large body mass index,but it generally has the advantages of short operation time,less intraoperative bleeding,less damage to the tissue around the middle and posterior columns,less irritation to the spinal nerves,large effective area of bone graft,and more lesion clearance.Both procedures have their own characteristics,so the surgical plan needs to be selected according to the patient’s radiology and condition.