斜外侧椎间融合辅助侧方钉板内固定治疗Ⅰ、Ⅱ度腰椎滑脱症的早期疗效

The Early Therapeutic Efficacy of Olif-Assisted Lateral Interbody Fusion with Plate Internal Fixation for GradesⅠ、ⅡLumbar Spondylolisthesis

目的观察腰椎斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)辅助侧方钉板内固定治疗Ⅰ、Ⅱ度腰椎滑脱的早期临床疗效与安全性。方法回顾性分析2020年6月至2023年6月广西中医药大学附属国际壮医医院的54例腰椎滑脱症患者的临床资料,按不同的手术方式分为腰椎侧方钉板内固定辅助OLIF手术组(观察组,21例)和传统后路减压融合内固定手术组(对照组,33例)。观察组,男11例,女10例;年龄55~82岁,平均(64.20±8.90)岁。对照组,男15例,女18例;年龄55~88岁,平均(64.80±8.70)岁。比较两组手术时长、术中失血量、术后引流量、住院时间。术前及术后1周、4周、6个月采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及日本骨科协会(Japanese orthopedic association,JOA)脊柱评分评价腰椎功能。结果两组患者均获得6个月以上随访。两组在手术时长、术中失血量、术后引流量、住院时间方面差异均有统计学意义(P<0.05)。术后1周和术后4周观察组的腰痛VAS评分低于对照组(P<0.05);术后4周时,观察组的JOA评分高于对照组(P<0.05);术后1周和术后4周时,观察组的ODI指数低于对照组(P<0.05)。观察组并发症发生率4.76%,对照组并发症发生率9.09%,两组并发症比较差异无统计学意义(P>0.05)。结论相比传统后路减压融合内固定术,腰椎OLIF辅助侧方钉板内固定治疗腰椎滑脱具有较好的早期临床疗效和安全性,且手术创伤更小,术中失血量及术后引流量更少,住院时间更短,可更早减轻疼痛,改善腰椎功能。

Objective To assess the early clinical effectiveness and safety of oblique lateral interbody fusion(OLIF)augmented by lateral plate internal fixation in the management of lumbar spondylolisthesis gradesⅠ、Ⅱ.Methods A retrospective analysis was performed on clinical data from 54 patients with lumbar spondylolisthesis,treated at the International Zhuang Medicine Hospital affiliated with Guangxi University of Chinese Medicine between June 2020 and June 2023.Based on surgical techniques,patients were categorized into two groups:The observation group(21 patients)undergoing lateral plate internal fixation-assisted OLIF,and the control group(33 patients)receiving traditional posterior decompression and fusion internal fixation surgery.The observation group included 11 males and 10 females,aged 55 to 82 years,with a mean age of(64.20±8.90)years.The control group included 15 males and 18 females,aged 55 to 58 years,with a mean age of(64.80±8.70)years.Comparative analysis was conducted on surgery duration,intraoperative blood loss,postoperative drainage volume,and hospital stay between the groups.The lumbar function was evaluated using the pain visual analogue scale(VAS),Oswestry disability index(ODI),and Japanese orthopedic association(JOA)spinal scores before surgery and at 1 week,4 weeks,and 6 months postoperatively.Results All patients completed a follow-up period exceeding 6 months.Significant differences were observed between the groups in surgery duration,intraoperative blood loss,postoperative drainage volume,and hospital stay(P<0.05).Postoperatively,the observation group exhibited lower VAS scores for lower back pain at 1 week and 4 weeks compared to the control group(P<0.05).At 4 weeks postoperatively,the observation group had higher JOA scores than the control group(P<0.05).Additionally,the observation group showed lower ODI scores at 1 week and 4 weeks postoperatively compared to the control group(P<0.05).The complication incidence was 4.76%in the observation group and 9.09%in the control group,with no statistically significant difference between the groups(P>0.05).Conclusion Compared to traditional posterior decompression and fusion internal fixation surgery,lumbar lateral plate internal fixation-assisted OLIF for lumbar spondylolisthesis gradesⅠ、Ⅱdemonstrates superior early clinical effectiveness and safety,with reduced surgical trauma,less intraoperative and postoperative bleeding,shorter hospital stay,earlier pain relief,and enhanced lumbar function.