LLIF与TLIF对腰椎矢状面序列影响的比较  

Effect of lateral lumbar interbody fusion versus transforminal lumbar interbody fusion on sagittal lumbar alignment

作　　者：易红蕾 许俊杰 陈虎 马向阳[1] 夏虹 艾福志 王建华 章凯 吴增晖 YI Hong-lei;XU Jun-jie;CHEN Hu;MA Xiang-yang;XIA Hong;AI Fu-zhi;WANG Jian-hua;ZHANG Kai;WU Zeng-hui(Department of Orthopaedics,General Hospital of PLA Southern Theater;Postgraduate Institute,Southern Medical University,Guangzhou 510000,China)

机构地区：[1]中国人民解放军南部战区总医院 [2]南方医科大学研究生院,广州510000

出　　处：《中国矫形外科杂志》2020年第14期1278-1282,共5页Orthopedic Journal of China

基　　金：军队医学科技青年培育计划孵化项目(编号:19QNP040);广州市科技计划项目(编号:201904010349)。

摘　　要：[目的]比较LLIF与TLIF对腰椎矢状面序列的影响。[方法]回顾分析2012年3月~2016年10月因腰椎退变性疾病进行LLIF与TLIF的患者126例(149个节段),其中LLIF组59例(67个节段),TLIF组68例(81个节段)。比较两组手术椎间隙高度、局部Cobb角和腰椎整体前凸(L1~S1)角度。[结果]手术椎间隙高度,LLIF组术后1周较术前增加(2.63±1.81)mm(P<0.05),末次随访较术前增加(0.94±2.22)mm(P<0.05)。而TLIF组术后1周较术前增加(2.77±1.71)mm(P<0.05),末次随访时仅较术前增加(0.90±1.77)mm,差异无统计学意义(P>0.05)。LLIF组术前、术后1周和末次随访时局部后凸Cobb角无显著变化(P>0.05)。而TLIF组术后及末次随访局部Cobb角显著大于术前(P<0.05)。两组患者腰椎(L1~S1)整体Cobb角自术前、术后1周至末次随访时有增加趋势,但差异无统计学意义(P>0.05);相应时间点两组间的差异亦无统计学意义(P>0.05)。但是LLIF组有23例患者29个间隙行辅助后路椎弓根螺钉固定(PS),术后1周和末次随访时局部Cobb角与术前相比均有明显改善(P<0.05),与全部辅助PS固定的TLIF组类似。[结论]LLIF能更好维持椎间隙高度,辅以后路椎弓根螺钉加压固定更有利于重建腰椎局部前凸。[Objective]To compare the sagittal lumbar alignments on radiographs between lateral lumbar interbody fusion(LLIF)versus transforminal lumbar interbody fusion(TLIF).[Methods]A retrospective study was done on 126 patients who underwent surgical treatment for lumbar degenerative disc disease involving 149 segments from March 2012 to October 2016.Of them,59 patients(67 segment)received LLIF,while the remaining 68 patients(81 segments)had TLIF.The radiographic sagittal lumbar parameters,including intervertebral space height of the affected disc,local Cobb's angle and total lumbar lordosis Cobb's angle,were compared between the two groups.[Results]The intervertebral space height significantly increased to(2.63±1.81)mm at 1 week postoperatively,and(0.94±2.22)mm at the latest follow-up more than that before operation in the LLIF group,whereas increased to(2.77±1.71)mm at 1 week after operation(P<0.05),and(0.90±1.77)mm at the latest followup in the TLIF groups,the latter proved not statistically significant(P>0.05).The local Cobb's angle remained unchanged in the LLIF group among the time points before operation,at 1 week after operation and the latest follow-up(P>0.05),whereas significantly increased in the TLIF group postoperatively compared with that before operation(P<0.05).The total lumbar Cobb's angles were inclined to increase over time in both groups but without statistical significance(P>0.05),additionally were not statistically different between the two groups at any matching time point(P>0.05).In comparison of the 23 patients(29 segments)with additional pedicle screw fixation in LLIF group with the all patients(81 segments)in TLIF group,there were no statistically significant differences noticed between them regarding to variations of local Cobb's angles from time point before operation to 1 week after operation and the latest follow up(P>0.05).[Conclusion]The LLIF is beneficial to maintain the involved intervertebral space height,while pedicle screw fixation facilitates to reconstruct lumbar lordosis.

关 键 词：侧方椎间融合术 经椎间孔椎间融合术 腰椎前凸 矢状面序列 

分 类 号：R687[医药卫生—骨科学]