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Received:May 17, 2023 Published Online:January 20, 2024
Received:May 17, 2023 Published Online:January 20, 2024
中文摘要: 目的 基于脊柱-骨盆解剖学和腰椎滑脱力学评估斜外侧椎间融合术(OLIF)与小切口经椎间孔椎间融合术(MIS-TLIF)对老年退行性腰椎滑脱(DLS)的治疗效果。
方法 回顾性选取2020年4月至2022年3月于沧州中西医结合医院行手术治疗的老年DLS患者122例为研究对象,接受OLIF术治疗的59例为OLIF组,接受MIS-TLIF手术治疗的63例为MIS-TLIF组。收集两组患者临床资料,包括手术情况、术前、术后即刻和术后12个月的滑脱参数[椎间隙高度(DH)、局部后凸角(SK)、腰椎滑脱率(SP)、滑脱角(SA)]、腰椎骨盆解剖学参数[L1椎体中心至骶骨垂线间距离(LASD)、腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、骨盆入射角(PI)]。采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估患者疼痛感受和腰部功能。
结果 相较于MIS-TLIF组,OLIF组手术时间、住院时间和切口长度更短,术中出血量和术后引流量更少(P<0.01)。相较于术前,两组患者术后即刻和术后1年滑脱参数中DH均增大,SK、SP、SA均减小(P<0.05),〖JP2〗腰椎骨盆解剖学参数中LASD和PT明显减小,LL、SS明显增大(P<0.05),PI则无显著变化(P>0.05);而VAS评分和ODI明显降低(P<0.05)。术后同时间点OLIF组DH较MIS-TLIF组更大、SK更小(P<0.01),其他滑脱力学参数和腰椎骨盆解剖学参数、VAS评分和ODI两组间差异均无统计学意义(P>0.05)。
结论 OLIF术和MIS-TLIF术对于老年DLS患者的脊柱-骨盆解剖学和腰椎滑脱力学参数、疼痛程度和腰部功能均有较好的改善效果,且效果大致相似,但OLIF手术时间、住院时间和切口长度更短,术中出血量和术后引流量更少,具有明显优势。
中文关键词: 斜外侧椎间融合术 小切口经椎间孔椎间融合术 退行性腰椎滑脱 滑脱力学 脊柱-骨盆解剖学
Abstract:Objective To evaluate the therapeutic effects of oblique lateral interbody fusion (OLIF) and minimally invasive transforminal lumbar interbody fusion (MIS-TLIF) on degenerative lumbar spondylolisthesis (DLS) in the elderly based on spinal pelvic anatomy and lumbar spondylolisthesis mechanics.
Methods A retrospective study was conducted on 122 elderly patients with DLS who underwent surgical treatment in Cangzhou Hospital of Integrated Chinese and Western Medicine from April 2020 to March 2022. Fifty-nine patients who received OLIF surgery were as OLIF group, while 63 patients who received MIS-TLIF surgery were as MIS-TLIF group. The clinical data of operation, pre-operation, immediately after operation and 12 months after operation were collected from two groups of patients, including the spondylolisthesis parameters [intervertebral height (DH), local kyphosis angle (SK), lumbar spondylolisthesis rate (SP), spondylolisthesis angle (SA)], lumbar pelvic anatomical parameters [L1 distance between the center of the vertebral body and the perpendicular line of the sacrum (LASD), lumbar lordosis angle (LL), sacral inclination angle (SS), pelvic inclination angle (PT) and pelvic incidence angle (PI)]. Visual Analogue Scale for Pain (VAS) score and the Oswestry Dysfunction Index (ODI) were used to assesse pain perception and lumbar function.
Results Compared with the MIS-TLIF group, the OLIF group had shorter operative time, hospital stay and incision length, less intraoperative bleeding and postoperative drainage flow (P<0.01). In immediate period and 1 year after surgery compared to preoperative levels, both groups of patients showed an increase in DH, a decrease in SK, SP and SA (P<0.05), and a significant decrease in LASD and PT, a significant increase in LL and SS (P<0.05), but no significant change in PI (P>0.05); the VAS score and ODI decreased significantly (P<0.05). At the same time point after surgery, the OLIF group had a larger DH and a smaller SK compared with the MIS-TLIF group (P<0.01), and there was no significant difference in other mechanical parameters of spondylolisthesis, lumbar pelvic anatomy parameters, VAS score and ODI between the two groups (P>0.05).
Conclusion OLIF and MIS-TLIF have good improvement effects on the spine pelvic anatomy, mechanical parameters of lumbar spondylolisthesis, pain degree, and lumbar function in elderly patients with DLS, and the effects are similar, but when using OLIF, the operation time, hospitalization time, and incision length are shorter, and the intraoperative blood loss and postoperative drainage are less, which has obvious advantages.
keywords: Oblique lateral intervertebral fusion Minimally invasive transforminal lumbar interbody fusion Degenerative lumbar spondylolisthesis Spondylolisthesis mechanics Spinal pelvic anatomy
文章编号: 中图分类号:R681.5 文献标志码:A
基金项目:河北省2023年度医学科学研究课题(20232137)
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