单纯斜外侧入路与后路腰椎椎间融合术治疗Ⅰ度单节段退行性腰椎滑脱的近期疗效比较

Comparison of the short-term clinical effects of stand-alone oblique lateral interbody fusion and posterior lumbar interbody fusion in the treatment of degree I single-segment degenerative lumbar spondylolisthesis

中文关键词:  退行性腰椎疾病  后路腰椎椎间融合术  单纯斜外侧腰椎椎间融合术

英文关键词:Degenerative lumbar diseases  Posterior lumbar interbody fusion  Stand-alone oblique lateral interbody fusion

中文摘要:

  【摘要】 目的：比较单纯斜外侧入路（stand-alone oblique lateral interbody fusion，SA OLIF）与后路腰椎椎体间融合术（posterior lumbar interbody fusion，PLIF）治疗Ⅰ度单节段退行性腰椎滑脱（degenerative lumbar spondylolisthesis，DLS）的近期临床疗效。方法：回顾性分析2019年3月～2021年8月收治的80例Ⅰ度单节段退行性腰椎滑脱患者资料。根据手术入路不同，分为SA OLIF组（38例）和PLIF组（42例）。比较两组患者的术中出血量、手术时间、术后引流量、术后下地活动时间、术后住院日、并发症发生率，测量手术前后及随访时手术节段的椎间隙高度（disc height，DH）、椎间孔高度（foraminal height，FH）、滑脱角（spondylolisthesis angle，SA）、融合率（fusion rate，FR）。采用疼痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评价近期临床疗效。结果：术中出血量（61.3±21.3mL vs 123.5±22.4mL）、手术时间（89.8±30.1min vs 112.1±15.2min）、术后引流量（44.2±23.2mL vs 163.5±22.2mL）、术后下地活动时间（2.0±1.0d vs 4.2±2.1d）、术后住院日（5.8±3.0d vs 9.2±5.3d）及并发症发生率（5.3% vs 19.1%）比较，SA OLIF 组均少于PLIF组（P<0.05）。术后1周时，SA OLIF组ODI[（19.3±6.6）％ vs （30.9±8.3）％]及腰部VAS评分（2.3±0.5 vs 3.0±1.0）低于PLIF组（P<0.05）；术后3个月至末次随访，两组ODI及VAS评分差异无统计学意义（P>0.05）。术后随访时间内，SA OLIF组DH、FH增高程度高于PLIF组（P<0.05），SA、FR两组比较差异无统计学意义（均P>0.05）。结论：SA OLIF和PLIF治疗Ⅰ度单节段退行性腰椎滑脱同样安全、有效，但SA OLIF具有手术创伤小、恢复快等优势，并且对椎间隙有更好的撑开效果。

英文摘要:

  【Abstract】 Objectives: To compare the short-term clinical effects of stand-alone oblique lateral interbody fusion(SA OLIF) and posterior lumbar interbody fusion(PLIF) in the treatment of degree I single-segment degenerative lumbar spondylolisthesis. Methods: The data of 80 patients with degree I single-segment degenerative lumbar spondylolisthesis who met with the inclusion criteria of this study between March 2019 and August 2021 were retrospectively analyzed. The patients were divided into the SA OLIF group(38 cases) and PLIF group(42 cases). The intraoperative blood loss, operative time, postoperative drainage volume, postoperative ambulation time, postoperative length of hospital stay, and complication rate were compared between the two groups of patients. The disc height(DH), foraminal height(FH), spondylolisthesis angle(SA), and fusion rate(FR) were measured before and after surgery and during follow-up. The visual analogue scale(VAS) and Oswestry disability index(ODI) were used to evaluate the short-term clinical efficacy. Results: The intraoperative blood loss(61.3±21.3mL vs 123.5±22.4mL), operative time(89.8±30.1min vs 112.1±15.2min), postoperative drainage volume(44.2±23.2mL vs 163.5±22.2mL), postoperative ambulation time(2.0±1.0d vs 4.2±2.1d), postoperative hospital stay(5.8±3.0d vs 9.2±5.3d), and complication rate(5.3% vs 19.1%) were all less in the SA OLIF group than those in the PLIF group(P<0.05). At 1 week postoperatively, the ODI[(19.3±6.6)% vs (30.9±8.3)%] and lower back pain VAS scores(2.3±0.5 vs 3.0±1.0) of the SA OLIF group were lower than those in the PLIF group(P<0.05), but no statistical difference was there between the two groups at 3 months after surgery and final follow-up(P>0.05). During postoperative follow-up, the postoperative increases of DH and FH in the SA OLIF group were higher than those in the PLIF group(P<0.05), and there was no significant difference in SA and FR after surgery between groups(P>0.05). Conclusions: SA OLIF and PLIF are equally safe and effective in treating degree I single-segment degenerative lumbar spondylolisthesis, However, SA OLIF has the advantages of less surgical trauma, faster recovery, and better opening effect on the intervertebral space.