斜外侧入路和经椎间孔入路椎间融合术在腰椎退变性侧凸的疗效比较  

A comparative study of the efficacy and complications of oblique lumbar interbody fusion and transforaminal lumbar interbody fusion in lumbar degenerative scoliosis

作　　者：何达[1] 何蔚 孙宇庆[1] 行勇刚[1] 袁强[1] 刘波[1] 王玉梅[1] 田伟[1] He Da;He Wei;Sun Yuqing;Xing Yonggang;Yuan Qiang;Liu Bo;Wang Yumei;Tian Wei(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京 100035

出　　处：《中华骨科杂志》2020年第8期515-525,共11页Chinese Journal of Orthopaedics

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.18525);北京积水潭医院院级医工企交叉培育项目(YGQ-201907)。

摘　　要：目的比较斜外侧椎间融合术(oblique lumbar interbody fusion,OLIF)和经椎间孔椎间融合术(transforminal lumbar interbody fusion,TLIF)治疗腰椎退变性侧凸的临床疗效。方法回顾性分析2015年1月至2018年5月治疗116例腰椎退变性侧凸合并椎管狭窄症患者资料。根据手术方式,将患者分为两组,其中56例患者采用OLIF入路[OLIF组,男21例,女35例;年龄(65.2±8.7)岁;Lenke?SilvaⅡ型41例,Ⅲ型15例]和60例采用TLIF入路[TLIF组,男19例,女41例;年龄(61.3±11.6)岁;Lenke?SilvaⅡ型43例,Ⅲ型17例]。比较两组手术前后视觉模拟评分(visual analogue scale,VAS)、Os?westry功能障碍指数(Oswestry disability index,ODI)评分及并发症;分析两组的各自手术前后的腰椎矢状位、冠状位Cobb角和顶椎中心偏移距离。结果OLIF组和TLIF组VAS评分分别由术前的(7.7±1.6)分和(8.1±1.2)分降至末次随访时的(1.9±1.5)分和(2.2±0.9)分;两组比较差异无统计学意义。OLIF组和TLIF组ODI分别从术前47.5%±9.1%和52.6%±5.8%增加到末次随访时的22.4%±6.7%和25.1%±8.4%;两组比较差异无统计学意义。矢状位Cobb角,术前OLIF组为8.6°±5.7°,末次随访时为23.6°±4.3°;TLIF组术前为9.2°±4.2°,末次随访时为21.3°±4.8°;末次随访时两组比较差异有统计学意义(t=2.68,P=0.01)。腰椎冠状位Cobb角,OLIF组术前为16.4°±9.6°,末次随访时为2.8°±2.1°;TLIF组术前为15.2°±7.8°,末次随访时为6.4°±2.7°;末次随访时两组比较差异有统计学意义(t=-7.96,P<0.001)。顶椎中心偏移距离,术前OLIF组为(26.3±9.4)mm,末次随访时为(4.3±1.9)mm;TLIF组术前为(23.4±5.5)mm,末次随访时为(7.5±4.2)mm;末次随访时两组比较差异有统计学意义(t=-5.26,P=0.03)。OLIF组融合率为97.7%(127/130),TLIF组为91.1%(164/180),两组比较差异无统计学意义。神经并发症发生率:OLIF组为16.1%(9/56),TLIF组为8.3%(5/60),两组比较差异无统计学意义。OLIF组椎间融合器塌陷率12.3%(16/130),TLIF组�Objective To compare the clinical effects of oblique lumbar interbody fusion(OLIF)and transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar degenerative scoliosis.Methods A retrospective study was performed in 116 patients with lumbar degenerative scoliosis and spinal stenosis,who were admitted to Beijing Jishuitan Hospital from January 2015 to May 2018.The patients were divided into two groups according to the surgical method.Among them,56 patients underwent the OLIF approach(OLIF group),consisting of 21 men and 35 women,with an average age of 65.2±8.7 years.According to Lenke-Silva classification,there were 41 cases of type II and 15 cases of type III in OLIF group.60 cases underwent the TLIF approach(TLIF group),consisting of 19 men and 41 women,with an average age of 61.3±11.6 years.There were 43 cases of type II and 17 cases of type III in TLIF group.The preoperative and last follow up visual analogue scale(VAS)and Oswestry disability index(ODI)were compared between the two groups.The coronal and sagittal Cobb angle changing and the offset distance for apical midline of the lumbar vertebrae between pre-operation and last follow-up were measured.The respective complications of the two groups were collected.Results For OLIF group,VAS decreased from 7.7±1.6 at pre-operation to 1.9±1.5 at the last follow up;for TLIF group,VAS decreased from 8.1±1.2 at pre-operation to 2.2±0.9 at the last follow up.Although there were obvious improve for both group compared pre-operation to last follow-up,there was no significant difference between the two groups.For OLIF group,ODI decreased from preoperative 47.5%±9.1%to last follow up 22.4%±6.7%;for TLIF group,ODI decreased from preoperative 52.6%±5.8%to last follow up 25.1%±8.4%.Obvious changes were foundin both group between pre-operation and last follow up,but there was no significant difference between the two groups.For sagittal lumbar cobb angle,OLIF group changed from preoperative 8.6°±5.7°to last follow-up 23.6°±4.3°.TLIF group changed f

关 键 词：腰椎 脊柱侧凸 脊柱融合术 外科手术 微创性 

分 类 号：R687[医药卫生—骨科学]