斜外侧腰椎椎间融合术联合侧方一体化钢板与微创经椎间孔入路腰椎椎间融合术治疗单节段退行性腰椎椎管狭窄症的影像学和临床疗效  

Imaging and clinical efficacy of oblique lateral interbody fusion combined with lateral plate fixation and minimally invasive transforaminal lumbar interbody fusion for single-level degenerative lumbar spinal stenosis

作　　者：荣辉 于兴胜 张政 祁健 谭树森 Rong Hui;Yu Xingsheng;Zhang Zheng;Qi Jian;Tan Shusen(Department of Spinal Surgery,No.960 Hospital of Joint Logistics Support Force of Chinese PLA,Jinan 250031,Shandong,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院脊柱外科,济南250031

出　　处：《脊柱外科杂志》2025年第1期12-17,共6页Journal of Spinal Surgery

基　　金：山东第一医科大学校级教育教学改革研究课题(XM2022131)。

摘　　要：目的比较斜外侧椎间融合术联合侧方一体化钢板(OLIF-LF)与微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)治疗单节段退行性腰椎椎管狭窄症(DLSS)的影像学和临床疗效。方法回顾性分析2019年2月—2022年12月收治的54例单节段DLSS患者临床资料,其中31例采用MIS-TLIF治疗(MIS-TLIF组),23例采用OLIF-LF治疗(OLIF-LF组)。记录并比较2组患者一般情况、手术基本情况、手术前后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、椎间孔面积(IFA)、椎间孔高度(IFH)、椎间隙高度(IDH)、腰椎前凸角(LL)及融合率。结果所有手术顺利完成,所有患者随访13~19(16.3±2.7)个月。OLIF-LF组术中出血量、术后第1天引流量、手术时间和住院时间少于MIS-TLIF组,差异均有统计学意义(P<0.05)。2组患者术后即刻仍存在腰痛,但OLIF-LF组术后即刻和术后6个月时VAS评分低于MIS-TLIF组,差异均有统计学意义(P<0.05);2组患者腰痛均随着时间延长显著缓解,末次随访时2组VAS评分差异无统计学意义(P>0.05)。2组术后各时间点ODI较术前显著改善,并随时间推移进一步改善直至稳定,差异均有统计学意义(P<0.05);各时间点ODI组间差异无统计学意义(P>0.05)。2组术后各时间点IDH、IFH、IFA较术前显著改善,且术后各时间点OLIF-LF组IDH、IFH、IFA优于MIS-TLIF组,差异均有统计学意义(P<0.05)。OLIF-LF组末次随访时LL较术前显著改善,差异有统计学意义(P<0.05);MIS-TLIF组末次随访时LL与术前相比,差异无统计学意义(P>0.05)。术后1年,2组手术节段全部融合,融合率为100%。结论2种术式治疗单节DLSS均能获得满意的影像学和临床疗效。OLIF-LF的术中出血量和术后引流量更少,手术时间和术后住院时间更短,术后即刻腰痛缓解更显著,腰椎生理曲度恢复更好。Objective To compare the imaging and clinical efficacy of oblique lateral interbody fusion combined with lateral plate fixation(OLIF-LF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single-level degenerative lumbar spinal stenosis(DLSS).Methods From February 2019 to December 2022,the clinical data of 54 single-level DLSS patients were retrospectively analyzed,including 31 cases were treated with MIS-TLIF(MIS-TLIF group)and 23 with OLIF-LF(OLIF-LF group).The general condition,basic surgical information,visual analog scale(VAS)score,Oswestry disability index(ODI),intervertebral foraminal area(IFA),intervertebral foraminal height(IFH),intervertebral disc height(IDH),lumbar lordosis angle(LL)at pre-and post-operation,and the fusion rate were recorded and compared.Results All the surgeries were successfully completed,and all the patients were followed up for 13-19(16.3±2.7)months.The intraoperative blood loss,first day drainage volume,operation time and hospital stay in the OLIF-LF group were all less than those in the MIS-TLIF group,and the differences were statistically significant(P<0.05).Both groups of the patients still had lower back pain immediately after surgery,but the VAS score in the OLIF-LF group was lower than that in the MIS-TLIF group immediately after operation and at 6 months after operation,and the difference was statistically significant(P<0.05).Both groups of the patients showed significant relief of lower back pain over time,and there was no statistically significant difference in the VAS scores between the 2 groups at the final follow-up(P>0.05).Both groups showed significant improvement in the ODI at various postoperative time points compared to preoperative levels,and further improved over time until stability,with statistically significant differences(P<0.05).There was no statistically significant difference in the ODI between the 2 groups at each time point(P>0.05).At each postoperative time point,IDH,IFH,and IFA in both groups showed significant

关 键 词：腰椎 椎管狭窄 脊柱融合术 外科手术 微创性 

分 类 号：R681.533.2[医药卫生—骨科学]