OLIF与TLIF手术治疗腰椎滑脱症的近期疗效比较  

Comparison of early clinical effect between OLIF and TLIF in treatment of lumbar spondylolisthesis

作　　者：吴锐辉[1] 邓东海 黄星球[1] 史成龙 周云飞 梁栋梁[1] 廖绪强[1] WU Rui-hui;DENG Dong-hai;HUANG Xing-qiu;SHI Cheng-long;ZHOU Yun-fei;LIANG Dong-liang;LIAO Xu-qiang(Department of Orthopedics,the First People's Hospital of Foshan City,Foshan,Guangdong 528000,China)

机构地区：[1]佛山市第一人民医院骨科

出　　处：《中国骨与关节损伤杂志》2019年第11期1140-1144,共5页Chinese Journal of Bone and Joint Injury

基　　金：佛山市医学重点专科培育项目

摘　　要：目的比较斜向腰椎间融合术(OLIF)与经椎间孔入路腰椎间融合术(TLIF)治疗腰椎滑脱症的近期临床疗效。方法纳入自2017-03-2018-03分别采用OLIF与TLIF手术治疗的50例单节段腰椎滑脱症,TLIF组26例,OLIF组24例。比较2组手术时间、术中出血量、术后住院时间、术后疼痛VAS评分、ODI指数、椎间隙高度、椎间孔高度、腰椎滑脱复位情况。结果50例均获得6个月随访。与TLIF组比较,OLIF组术中出血量更少、术后住院时间更短、术后3 d疼痛VAS评分及ODI指数更低,差异有统计学意义(P<0.05);但2组手术时间、术后6个月疼痛VAS评分及ODI指数差异无统计学意义(P>0.05)。OLIF组术后3 d、3个月椎间隙高度、椎间孔高度优于TLIF组,差异有统计学意义(P<0.05);但2组术后6个月时椎间隙高度、椎间孔高度差异无统计学意义(P>0.05)。TLIF组与OLIF组术后3 d、6个月时腰椎滑脱程度差异无统计学意义(P>0.05)。结论OLIF手术治疗腰椎滑脱症具有手术创伤小、术后恢复快、早期症状改善明显等优点,其在保护腰椎后方结构的同时减少了对椎管的干扰,有效地提供前中柱支撑,更好地恢复椎间高度,并扩大椎间孔面积,从而达到间接减压的目的。Objective To compare the short-term clinical outcomes of oblique lumbar interbody fusion(OLIF)and transforaminal lumbar interbody fusion(TLIF)for treatment of lumbar spondylolisthesis.Methods From March 2017 to March 2018,50 patients with lumbar spondylolisthesis were enrolled in our research,24 cases underwent OLIF(OLIF group)and 26 cases underwent TLIF(TLIF group).The operation time,operation blood loss,postoperative length of hospital stay,visual analogue scale(VAS),Oswestry disability index(ODI),intervertebral disc height,intervertebral foramen height,and extent of spondylolisthesis were compared between two groups.Results Fifty patients were followed up 6 months.Compared with the TLIF group,the OLIF group had less operation blood loss and shorter postoperative length of hospital stay,as well as VAS and ODI 3 days after operation were lower,the difference was statistically significant(P<0.05).However,there was no significant different between two groups in the postoperative length of hospital stay,postoperative VAS score and ODI score after 6 months(P>0.05).The OLIF group was significantly superior to the TLIF group in the disc and foramen height at 3 days and 3 months postoperatively(P<0.05).However,there was no significant different between two groups at 6 months follow-up(P>0.05).Additionally,there were no significant differences between two groups in the postoperative grade of spondylolisthesis at 3 days and 6 months postoperatively(P>0.05).Conclusion In the treatment of lumbar spondylolisthesis,OLIF has the advantages of less blood loss,rapid postoperative recovery,and obvious improvement of early symptom.It can not only protect the posterior structure of the lumbar spine,but also reduce the interference to the spinal canal.Moreover it also effectively provide anterior and middle column support,better restore the intervertebral height,and expand the intervertebral pore area,so as to achieve the purpose of indirect decompression.

关 键 词：腰椎滑脱症 斜向腰椎间融合术 经椎间孔入路腰椎间融合术 内固定 经皮椎弓根钉 

分 类 号：R681.5[医药卫生—骨科学]