经椎间孔入路腰椎椎间植骨融合术与经后路腰椎椎体间植骨融合术治疗老年退行性腰椎滑脱症患者的效果比较

Comparison of effects of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion with bone graft in treatment of elderly patients with degenerative lumbar spondylolisthesis

目的:比较经椎间孔入路腰椎椎间植骨融合术(TLIF)与经后路腰椎椎体间植骨融合术(PLIF)治疗老年退行性腰椎滑脱症患者的效果。方法:回顾性分析2020年7月至2022年7月该院收治的110例老年退行性腰椎滑脱症患者的临床资料,依据手术入路方式不同将其分为研究组53例与对照组57例。研究组采用TLIF治疗,对照组采用PLIF治疗,比较两组围术期指标(手术时间、术中出血量、术后引流量、住院时间)水平,手术前后疼痛程度[视觉模拟评分法(VAS)]评分、腰椎功能[下腰痛日本骨科协会评估治疗(JOA)、Oswestry功能障碍指数(ODI)]评分,以及术后并发症发生率。结果:研究组手术时间、住院时间均短于对照组,术中出血量、术后引流量均少于对照组,差异有统计学意义(P<0.05);术后6、12个月时,两组VAS评分均低于术前,但组间比较,差异均无统计学意义(P>0.05);术后12个月,两组下腰痛JOA评分均高于术前,ODI评分均低于术前,但组间比较,差异均无统计学意义(P>0.05);两组切口感染、肺部感染、健侧神经损伤发生率比较,差异均无统计学意义(P>0.05);研究组患侧神经损伤发生率低于对照组,差异有统计学意义(P<0.05)。结论:TLIF与PLIF治疗老年退行性腰椎滑脱症患者均可有效减轻疼痛程度,恢复腰椎功能,但其改善围术期指标水平,降低侧神经损伤发生率的效果优于PLIF治疗。

Objective:To compare effects of transforaminal lumbar interbody fusion(TLIF)and posterior lumbar interbody fusion(PLIF)with bone graft in treatment of elderly patients with degenerative lumbar spondylolisthesis.Methods:The clinical data of 110 elderly patients with degenerative lumbar spondylolisthesis admitted to this hospital from July 2020 to July 2022 were retrospectively analyzed.According to different surgical approaches,they were divided into study group(53 cases)and control group(57 cases).The study group was treated with TLIF,while the control group was treated with PLIF.The perioperative indexes(operation time,intraoperative blood loss,postoperative drainage volume and hospitalization time),the pain degree[visual analogue scale(VAS)]score before and after the surgery,the lumbar function[Japanese Orthopaedic Association(JOA)score for low back pain,the Oswestry dysfunction index(ODI)]score,and the incidence of postoperative complications were compared between the two groups.Results:The operation time and the hospitalization time of the study group were shorter than those of the control group,the intraoperative blood loss and postoperative drainage volume were both lower than those of the control group,and the differences were statistically significant(P<0.05).At 6 and 12 months after the surgery,the VAS scores of both groups were lower than those before the surgery,but there were no statistically significant differences between the groups(P>0.05).At 12 months after the surgery,the JOA scores of low back pain in the two groups were higher than those before the surgery,and the ODI scores were lower than were before the surgery,but there were no significant differences between the two groups(P>0.05).There were no statistically significant differences in the incidence of incision infection,lung infection,and healthy side nerve injury between the two groups(P>0.05).The incidence of nerve injury on the affected side in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions:TLIF and PLIF in the treatment of the elderly patients with degenerative lumbar spondylolisthesis can effectively reduce the degree of pain and restore the lumbar function,but TLIF can improve the levels of perioperative indexes and reduce the incidence of lateral nerve injury.Moreover,it is superior to PLIF treatment.