斜外侧入路椎间融合术联合不同固定方式治疗腰椎滑脱症的早期疗效分析

The early efficacy analysis of oblique lateral interbody fusion combined with different fixation for the treatment of lumbar degenerative spondylolisthesis

中文关键词:  腰椎滑脱症  斜外侧入路椎间融合术  侧方钢板  椎弓根螺钉

英文关键词:Lumbar spondylolisthesis  Oblique lateral interbody fusion  Lateral plate  Pedicle screw

中文摘要:

  【摘要】 目的：比较斜外侧入路椎间融合术（oblique lateral interbody fusion，OLIF）联合不同固定方式治疗腰椎滑脱症的早期临床疗效及并发症情况。方法：回顾性分析2020年1月~2022年1月于我院接受OLIF治疗的腰椎滑脱症患者53例，其中男性24例，女性29例，年龄62.17±9.72岁；OLIF联合侧方钢板（lateral plate，LP）固定组24例（LP组），OLIF联合后方椎弓根螺钉（pedicle screw，PS）内固定组29例（PS组）。两组患者的年龄、性别及体质指数 （body mass index，BMI）等人群特征均无明显统计学差异。记录两组患者的手术时间、术中出血量、术后并发症情况。于术前、术后1周、3个月及12个月分别采用腰痛视觉模拟评分（visual analog scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）及影像学指标如椎间隙高度（disc height，DH）、椎间孔高度（foraminal height，FH）、椎管横截面积（cross-sectional area，CSA）来综合评价临床疗效。末次随访时根据Bridwell评估方法对椎间融合率进行评估。结果：随访时间为13.2±6.5个月（12~16个月）。LP组手术时间及术中出血量均显著性低于PS组（75.41±11.53min vs 127.05±5.62min，P<0.05；39.55±5.32mL vs 89.81±9.62mL，P<0.05）。两组患者术前VAS评分、ODI指数均无统计学差异，术后1周LP组VAS评分及ODI均优于PS组[3.05±0.67 vs 4.55±0.39，P<0.01；（17.36±2.76）% vs （22.80±6.02）%，P<0.01]，但这种差异在术后1年时消失。LP组术前DH、FH及CSA分别为8.96±1.23mm，16.18±3.49mm和88.95±14.79mm2，术后1年分别为12.53±3.47mm、20.14±3.12mm、124.83±7.56mm2，较前均明显改善；PS组术前DH、FH及CSA分别为8.66±2.21mm、16.35±5.19mm、89.23±12.18mm2，术后1年分别为12.32±4.67mm、20.86±3.44mm、125.75±7.76mm2，较前均明显改善，但各参数在同期随访时无组间差异。LP组22例实现椎间融合，融合率为 91.67%，略低于PS组（93.10%），但无统计学差异。LP组融合器沉降2例，腰骶丛损伤2例；PS组融合器沉降2例，腰骶丛损伤1例，并发症发生率组间差异无统计学意义（P>0.05）。结论：OLIF+LP及OLIF+PS均可有效治疗腰椎滑脱症，相比于OLIF+PS，OLIF+LP的出血量更少、手术时间更短，而临床效果相当。

英文摘要:

  【Abstract】 Objectives: The purpose of this study was to compare the clinical efficacies and complications of oblique lateral interbody fusion(OLIF) combined with two different fixations for the treatment of lumbar degenerative spondylolisthesis(LDS). Methods: 53 patients with LDS who underwent OLIF between January 2020 and January 2022 were retrospectively analyzed, including 24 males and 29 females, with an average age of 62.17±9.72 years. Among the patients, 24 were treated with OLIF combined with lateral plate(LP)(the LP group) and 29 were treated with OLIF combined with pedicle screw(PS)(the PS group). There were no significant differences in age, gender, body mass index(BMI) and other population characteristics between the two groups. The operative time, blood loss, and the complications were recorded. Before operation, at postoperative 7d, 3 and 12 months, the visual analog scale(VAS) score, Oswestry disability index(ODI), and the imaging parameters such as disc height(DH), foraminal height(FH) and cross-sectional area(CSA) were also evaluated. At final follow-up, the rate of intervertebral fusion was assessed according to the Bridwell assessment system. Results: The patients were followed up for 13.2±6.5(range 12-16) months. LP group was less than PS group in operative time and blood loss(75.41±11.53min vs 127.05±5.62min, P<0.05; 39.55±5.32mL vs 89.81±9.62mL, P<0.05). There were no significant differences in preoperative VAS score and ODI between the two groups. One week after surgery, both VAS and ODI in LP group improved much better than those of PS group[3.05±0.67 vs 4.55±0.39, P<0.01; (17.36±2.76)% vs (22.80±6.02)%, P<0.01]. However, the difference disappeared at 1 year of follow-up. In LP group, the DH, FH and CSA were 8.96±1.23mm, 16.18±3.49mm and 88.95±14.79mm2 respectively before operation, which were significantly improved to 12.53±3.47mm, 20.14±3.12mm, 124.83±7.56mm2 one year after surgery, respectively. Also, the preoperative DH, FH and CSA were 8.66±2.21mm, 16.35±5.19mm, and 89.23±12.18mm2 respectively in PS group, and 12.32±4.67mm, 20.86±3.44mm, 125.75±7.76mm2 one year after surgery, which were also significantly improved than before. However, there was no difference between groups at the same time points. The intervertebral fusion was achieved in 22 cases(91.6%) in LP group, which was slightly lower than that in the PS group(93.10%) without statistical significance. In LP group, two patients experienced cage subsidence and two patients occurred lumbosacral plexus injury, while two patients experienced cage subsidence and only one patient occurred lumbosacral plexus injury in PS group. There was no significant difference between the two groups(P>0.05). Conclusions: Both OLIF+LP and OLIF+PS are effective method for the treatment of lumbar spondylolisthesis. Comparing with OLIF+PS, OLIF+LP has comparable clinical effect, less blood loss and shorter operative time.