斜外侧腰椎椎间融合术与经椎间孔椎间融合术治疗退行性腰椎侧凸疗效比较  

Comparison of Oblique Lateral Lumbar Interbody Fusion and Transforaminal Interbody Fusion for The Treatment of Degenerative Lumbar Scoliosis

作　　者：潘玉军 时长江 穆怀昭[3] 张义龙[1] Pan Yujun;Shi Changjiang;Mu Huaizhao;Zhang Yilong(Department of Spine Surgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Department of Joint Surgery,Affiliated Hospital of Chengde Medical College,Hebeichengde 067000,China;Department of Trauma department of orthopedics,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院脊柱外科,067000 [2]承德医学院附属医院关节外科,067000 [3]承德医学院附属医院创伤骨科,067000

出　　处：《中华老年骨科与康复电子杂志》2021年第6期345-351,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：承德市科技计划项目(201801A050)。

摘　　要：目的探讨斜外侧腰椎椎间融合术(OLIF)与经椎间孔椎间融合术(TLIF)治疗退行性腰椎侧凸(DLS)的疗效差异。方法回顾性分析2017年2月至2019年2月我院收治的DLS患者134例,根据不同手术方式分为OLIF组(64例)和TLIF组(70例);比较两组患者的手术相关指标、并发症发生情况、融合率。分别于术前、术后6个月、2年评价视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),计算冠状位、矢状位Cobb角、腰椎前凸角、骶骨倾斜角、骨盆入射角。结果134例患者均获得完整随访,随访率100%,随访时间(35±4)个月。OLIF组手术时间[(243±39)min]显著高于TLIF组[(215±29)min,t=3.432,P=0.001],OLIF术组术中出血量[(411±34)ml]显著低于对照组[(653±42)ml,t=4.865,P<0.001];两组术后6个月、2年ODI指数、VAS评分以及冠状位Cobb角均低于术前,矢状位Cobb角、腰椎前凸角、骶骨倾斜角、骨盆入射角高于术前,但术后3个月、2年OLIF术组冠状位Cobb角[(22.2±3.2)°,(22.2±3.2)°]显著高于TLIF组[(20.1±2.0)°(20.1±2.0)°,t=4.534、t=4.798,P<0.001],术后3个月、2年OLIF组冠状位Cobb角[(3.2±0.4)°、(3.5±0.3)°],显著低于TLIF组[(5.5±1.0)°、(5.6±0.8)°,t=16.265、t=20.595,P<0.001],术后3个月、术后2年OLIF组腰椎前凸角[(47.2±3.2)°、(46.9±2.6)°]显著高于TLIF组[(39.2±3.2°、38.9±2.4°,t=14.602,t=18.498,P<0.001],术后3个月、2年OLIF组骶骨倾斜角[(34.8±4.3)°、(34.4±4.0)°]显著高于TLIF组[(30.4±4.2)°、(30.0±3.9)°,t=5.964,t=6.494,P<0.001]。结论TLIF术、OLIF术治疗DLS均能获得确切的近期疗效,OLIF术手术时间略长,但创伤更小,冠状位、矢状位矫正效果更好。Objective To investigate the difference between oblique lateral lumbar interbody fusion(OLIF)and transforaminal interbody fusion(TLIF)for the treatment of degenerative lumbar scoliosis(DLS).Methods A retrospective analysis of 134 patients with DLS admitted to our hospital from February 2017 to February 2019.According to different surgical methods,they were divided into OLIF operation group(64 cases)and TLIF operation group(70 cases),the two groups of patients were compared for operation related Indicators,complications,fusion rate were compared,and visual analog scale(VAS)and Oswestry disability index(ODI)were evaluated preoperatively,6 months,and 2 years postoperatively.The coronal position,sagittal Cobb angle,lumbar lordosis angle,sacral tilt angle,pelvic incidence angle were calculated.Results The operation time of the OLIF group was(243±39)min,which was significantly higher than that of the TLIF group(215±29)min,(t=3.432,P=0.001).The intraoperative blood loss in the OLIF group was(411±34)ml,Significantly lower than the control group(653±42)ml,(t=4.865,P<0.001);the ODI index,VAS score,and coronal Cobb angle of the two groups were lower than that of the operation 6 months after the operation and 2 years after the operation.The sagittal Cobb angle,lumbar lordosis angle,sacral inclination angle,and pelvic angle of incidence were higher than those before surgery,but the coronal Cobb angles in the OLIF surgery group were(22.2±3.2)°at 3 months and 2 years after surgery(22.2±3.2)°,significantly higher than(20.1±2.0)°,(20.1±2.0)°,(t=4.534,t=4.798,P<0.001)in the TLIF group,3 months after operation,2 years postoperatively,the coronal Cobb angles in the OLIF group were(3.2±0.4)°and(3.5±0.3)°,which were significantly lower than the(5.5±1.0)°and(5.6±0.8)°in the TLIF group,(t=16.265,t=20.595,P<0.001),the lumbar lordosis angles of the OLIF operation group were(47.2±3.2)°and(46.9±2.6)°at 3 months and 2 years after operation,which were significantly higher than those of TLIF(39.2±3.2)°,(38.9±2.4)°,(

关 键 词：斜外侧腰椎椎间融合术 经椎间孔椎间融合术 退行性腰椎侧凸 

分 类 号：R687.3[医药卫生—骨科学]