斜外侧与后路腰椎间融合治疗腰椎融合术后邻近节段退变性疾病的比较  

Comparison of Clinical Efficacy of Oblique Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion in the Treatment of Adjacent Segment Degenerative Diseases After Lumbar Fusion

作　　者：张盼可 朱广铎 任志楠 于磊[1] 朱剑 曹书严 宋鑫 镐英杰[1] Zhang Panke;Zhu Guangduo;Ren Zhinan(Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中国微创外科杂志》2022年第1期7-13,共7页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省医学科技攻关计划省部共建项目(SB201903001)。

摘　　要：目的比较斜外侧腰椎间融合(oblique lumbar interbody fusion,OLIF)和后路腰椎间融合(posterior lumbar interbody fusion,PLIF)治疗腰椎融合术后邻近节段退变性疾病的疗效。方法回顾性分析2016年1月~2019年12月腰椎融合术后邻近节段退变54例翻修手术资料,由患者选择手术方式,其中OLIF 25例,PLIF 29例,2组年龄、性别、手术节段、术前融合节段、邻近节段退变类型差异无统计学意义(P>0.05)。比较2组围术期指标及末次随访改良MacNab标准优良率。结果与PLIF组相比,OLIF组手术时间短[(111.8±42.4)min vs.(203.9±53.1)min,t=-6.695,P=0.000],术中出血少[(103.6±74.0)ml vs.(545.5±256.2)ml,t=-8.869,P=0.000],术后住院时间短[(8.5±2.2)d vs.(13.8±5.1)d,t=-5.154,P=0.000]。2组围术期并发症差异无统计学意义(P>0.05)。2组随访时间差异无统计学意义[(19.5±3.9)月vs.(18.1±3.8)月,t=1.352,P=0.182]。末次随访改良MacNab标准优良率,OLIF组96.0%(24/25),PLIF组89.7%(26/29),差异无统计学意义(χ2=0.788,P=0.375)。结论OLIF和PLIF治疗腰椎融合术后邻近节段退变性疾病均有良好疗效。与PLIF组相比,OLIF具有手术时间、住院时间短,术中出血少等优势。Objective To compare the clinical efficacy of oblique lumbar interbody fusion(OLIF)and posterior lumbar interbody fusion(PLIF)in the treatment of adjacent segment degenerative diseases after lumbar fusion.Methods A total of 54 patients with adjacent segment degeneration after lumbar fusion from January 2016 to December 2019 were retrospectively included.The patients were divided into the OLIF group(n=25)or PLIF group(n=29)according to their choice of different surgical methods.No significant differences in age,gender,surgical segment,preoperative fusion segment and type of adjacent segment degeneration were found between the two groups(P>0.05).The perioperative indicators and the modified MacNab criteria at the last follow-up between the two groups were compared.Results Compared with the PLIF group,the OLIF group had shorter operation time[(111.8±42.4)min vs.(203.9±53.1)min,t=-6.695,P=0.000],less intraoperative blood loss[(103.6±74.0)ml vs.(545.5±256.2)ml,t=-8.869,P=0.000],and shorter postoperative hospital stay[(8.5±2.2)d vs.(13.8±5.1)d,t=-5.154,P=0.000].There was no significant difference in perioperative complications between the two groups(P>0.05).No significant difference was found in follow-up time between the two groups[(19.5±3.9)month vs.(18.1±3.8)month,t=1.352,P=0.182].There were no significant differences in excellent and good rate between the OLIF group(96.0%,24/25)and the PLIF group(89.7%,26/29)at the final follow-up(χ^(2)=0.788,P=0.375).Conclusions Both OLIF and PLIF have good curative effects in the treatment of the adjacent segment degenerative diseases after lumbar surgery.However,compared with the PLIF,OLIF has advantages of shorter operation time,shorter hospital stay,and less intraoperative bleeding.

关 键 词：斜外侧腰椎间融合术 后路腰椎间融合术 腰椎邻近节段退变 翻修手术 

分 类 号：R68[医药卫生—骨科学]