中国微创外科杂志2024,Vol.24Issue(9) :593-598.DOI:10.3969/j.issn.1009-6604.2024.09.001

斜外侧入路与经椎间孔椎间融合术治疗退行性腰椎滑脱2年随访结果的对比研究

A Comparative Study of Oblique and Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis at Postoperative 2 Years

吴静晔 葛腾辉 李观清 敖进涛 徐忠宁 孙宇庆
中国微创外科杂志2024,Vol.24Issue(9) :593-598.DOI:10.3969/j.issn.1009-6604.2024.09.001

斜外侧入路与经椎间孔椎间融合术治疗退行性腰椎滑脱2年随访结果的对比研究

A Comparative Study of Oblique and Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis at Postoperative 2 Years

吴静晔 1葛腾辉 1李观清 1敖进涛 1徐忠宁 1孙宇庆1
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作者信息

  • 1. 首都医科大学附属北京积水潭医院脊柱外科,北京 100035
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摘要

目的 比较斜外侧入路椎间融合术(oblique lumbar interbody fusion,OLIF)和经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗退行性腰椎滑脱术后2年的临床疗效.方法 回顾性分析2017年7月~2020年9月OLIF(46例)和TLIF(45例)治疗退行性腰椎滑脱2年随访资料,融合范围1~2个腰椎节段.主要观察指标为术后2年疼痛视觉模拟量表(Visual Analogue Scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI),次要观察指标为术后2年影像学参数、椎间融合、融合器沉降和永久性神经损伤发生率.结果 OLIF和TLIF术后2年腰痛VAS[2(2,3)vs.2(2,2),P=0.943]、下肢痛 VAS[2(2,2)vs.2(2,2),P=0.988]和 ODI[17%(10%,22%)vs.14%(10%,22%),P=0.417]差异均无显著性.OLIF术后2年椎间高度优于TLIF[(11.9±1.5)mm vs.(9.2±2.0)mm,P<0.001],节段前凸角度优于TLIF(15.7°±7.2° vs.12.5°±5.9°,P=0.029),且融合器沉降率低[19.6%(9/46)vs.40.0%(16/40),P=0.037].2 组术后2 年融合率[93.5%(43/46)vs.87.5%(35/40),P=0.562]和永久性神经损伤发生率[4.3%(2/46)vs.6.7%(3/45),P=0.980]差异均无显著性.结论 对于退行性腰椎滑脱,短节段OLIF和TLIF术后2年在症状改善和融合率方面表现相似,但OLIF椎间高度和前凸角度恢复更显著,且融合器沉降率较低.

Abstract

Objective To compare the clinical outcomes between oblique lumbar interbody fusion(OLIF)and transforaminal lumbar interbody fusion(TLIF)for patients with degenerative spondylolisthesis during 2-year follow-ups.Methods Patients with symptomatic degenerative spondylolisthesis who underwent OLIF(46 cases)and TLIF(45 cases)between July 2017 and September 2020 with 2-year follow-ups were retrospectively reviewed.One level or two-level lumbar fusion were included.The primary outcomes were Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)at 2 years after surgery.The secondary outcomes included radiographic parameters,fusion rate,cage subsidence rate,and permanent nerve injury rate.Results No significantly different changes were noted in VAS-back[2(2,3)vs.2(2,2),P=0.943],VAS-leg[2(2,2)vs.2(2,2),P=0.988],and ODI[17%(10%,22%)vs.14%(10%,22%),P=0.417]between the OLIF group and the TLIF group,respectively.Greater restoration of disc height and segmental lordosis were obtained in the OLIF group[mean,(11.9±1.5)mm and 15.7°±7.2°]than in the TLIF group[mean,(9.2±2.0)mm and 12.5°±5.9°]at postoperative 2-year(P<0.001 and P=0.029).The subsidence rate was lower in the OLIF group than in the TLIF group[19.6%(9/46)vs.40.0%(16/40),P=0.037].The fusion rates at postoperative 2-year were 93.5%(43/46)in the OLIF group and 87.5%(35/40)in the TLIF group,having no significant difference(P=0.562).The rates of permanent nerve injury were similar between the two groups[4.3%(2/46)vs.6.7%(3/45),P=0.980]at postoperative 2-year.Conclusion Short segment OLIF doesn't show better clinical outcomes and fusion rate than TLIF for degenerative spondylolisthesis,except for greater disc height restoration,greater segmental lordosis,and lower subsidence rate at postoperative 2-year.

关键词

椎间融合术/斜外侧入路椎间融合术/腰椎滑脱/对比研究

Key words

Interbody fusion/Oblique lumbar interbody fusion/Lumbar spondylolisthesis/Comparative study

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基金项目

国家重点研发计划(2022YFC2407200)

国家重点研发计划(2022YFC2407204)

出版年

2024
中国微创外科杂志
北京大学

中国微创外科杂志

CSTPCD北大核心
影响因子:2.21
ISSN:1009-6604
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